Family-Oriented Treatment in Reducing Pediatric Obesity - Assignment Example

What is the role of holistic family-oriented treatment in reducing pediatric obesity Dissertation Assignment Outline of Salient Points Why does this topic interest you Attempt to investigate the immense ability of human self-healing (Self-healing is known; but not known how human beings can be guided to use that power themselves) The topic is original and unique (Basic and broad literature survey did not reveal any literature on this topic) Possibility to involve self in the research (The author can perform the research himself and specialty being holistic medicine) Personal belief that clinical holistic medicine at family levels may alter the current course of childhood obesity (The author personally believes that childhood obesity can be tackled by interventions at family levels, and since success from these interventions would involve permanent behavioural changes, a holistic intervention would be necessary) Causes to pursue The problem of childhood obesity exists (Literature and health data indicate the problem, prevalence, and rise of childhood obesity, which have future consequences with increased morbidity, mortality, and healthcare costs) Despite studies, no specific guidelines are available (Several studies are available, but there are no specific guidelines of intervention in the biomedical model of medicine that are successful in reducing the incidence and persistence of childhood obesity) Area of holistic medicine is under-researched (In the area of holistic medicine, there are indications that holistic medicine may be helpful, but search across databases revealed paucity of research. Whatever studies are available are empiric with inadequate or inappropriate design, and therefore conclusion from holistic research is not possible) Many gaps in available and existing research (The available and existing research has faulty methodology, based on presumptions than on critical review and authentic derivation of facts). Many unanswered questions (In many cases, inadequate knowledge on the biomedical factors related to obesity in childhood, the possible factors were not revealed, and as a result, the phenomenon of childhood obesity and its holistic medicine implications were less understood and hence remained unknown) Outside the mainstream healthcare system but holds significant implications (Mainstream biomedical model of healthcare can access this population, but that field is totally unaware of the holistic dimension of the requisite interventions, hence fails to implement them leading to failure to control childhood obesity) May outline the requisite behavioural changes using principles of holistic medicine (This author's knowledge and expertise in holistic medicine and ability to apply appropriate research methodology may lead to delineation of guidelines based on clinical holistic medicine that may indeed fruitfully lead to successful interventions culminating into behavioral changes in children) A Real Health Problem Childhood obesity is a health problem of upcoming times (Many studies and health service reports indicate epidemic rise in childhood obesity with an upward trend globally indicating the sustained nature of this health problem) Causes inherent in the health risk behaviors inherent in family environments (Studies indicate that the problem of childhood obesity is related to the lifestyle-related behavior patterns of the children with a seed in the family environments) Solutions of these problems lie in human endeavors to modify their own lifestyles (Biomedical solutions have been ineffective in controlling these problems, although these have been able to deliver the factors that cause childhood obesity. Behavioral theories pertinent to holistic medicine indicate that lifestyle change is a matter of behavioral modification, which may be initiated by awareness about the factors related to the problem, but sustenance of these changed behaviors must have an element of self-effort on the part of individuals at risk or already affected) Holistic family interventions to modify environments may be the clue (If behavior is a derivative of environment, modification of behavior can be accomplished through modification of the environment.) Holistic health approach may be very suitable to target pediatric population in order to modify these lifestyle behaviors when implemented within families (Since the children are maximally exposed to and influenced by family environment, family interventions may produce results. It is known that family interventions are best done through holistic methodologies, where lifestyle changes of the other members of the family would positively influence the relevant behaviors of these children) Preventive Approach Acquired diseases are preventable (The knowledge of preventive and social medicine has conclusively established that all acquired diseases have causative elements arising from environment or behavior and hence are preventable) Prevention has been demonstrated to be possible through sustained actions directed at families and individuals (Examples from other preventable diseases have also indicated that environmental, community, family, personal, lifestyle, and health behavioral interventions reduce the incidence of many chronic acquired diseases, especially when at risk individuals or families are targeted. For example cessation of smoking reduces coronary artery disease. Vaccination of families or children may reduce viral hepatitis or poliomyelitis. Improvement of sanitation and living conditions may reduce infectious diseases. Thus sustained action directed towards families and individuals may prevent many diseases). Target area is holistic (It is clear that the target area must intend to modify all the factors involved intricately in any given health problem. Evidently, the approach must be holistic rather than factorial.) Holistic approach of health promotion for behavior modification through broad health education and a life course approach for promotion of healthy behavior (Specifically with obesity, healthy and nutritious diet, availability of food elements, food behaviour, leisure activities and scope for it, and physical activities are important. These are mostly factors that are best implemented through awareness and health education. The behavioral change implemented and achieved must be sustained through the life course, and thus a holistic health promotion and promotion of healthy lifestyle behavior could be the only successful way) Expectations Holistic intervention in childhood may indeed bring about the desired individual behavioral changes (Example of other holistic behavioral approaches indicate intervention in childhood since these are not temporal, and these changes must be ingrained with the person to be continued and maintained throughout life) Holistic approach may facilitate building up a positive culture of health in these children (Holistic approach leads to awareness about self and the ability of self to implement and sustain a change, which may be picked up by these children who are at risk of developing obesity due to epidemiologic reasons prevalent within the community) This approach has been demonstrated to be efficacious in health improvement (Most research in holistic health demonstrated efficacy of this approach in improvement in health conditions, which are hitherto difficult to be controlled by the orthodox and conventional model of biomedical healthcare) These include a range of relevant areas such as physical activity, healthy eating behavior, and even emotional health (The areas that have been identified are physical activity, healthy eating behavior, and even emotional health, and it is to be insisted that all these factors must be addressed as a whole to bring about a change) Parental motivations to change may influence children from the very beginning, which may influence the children's future life behaviours related to obesity (Parents in families influence children most, and they can create environments for behavioral modification of the children, and in many cases, familial practice is known to be true and absolute by the children as a part of their health belief system. Thus it is not inordinate to hypothesize that holistic familial interventions keeping the parents at center could be instrumental in shaping children's behaviour patterns) My specialty is holistic medicine (I am a specialist in holistic medicine, and this knowledge may be used to design very successful interventions) Why do you feel you can provide additional information on this topic Childhood obesity is inadequately addressed (The rise in childhood obesity indicates this problem is inadequately addressed. Despite knowledge about the factors, the interventional concepts are fragmented and hence these are not associated with positive outcomes) Very less known about the cause and effect relationships of these parameters (Research indicates that only associated factors have been determined, but attempt to control these factors have encountered failure. This is possibly due to the fact that cause and effect relationship of these parameters in causation of childhood obesity are not established). Existing mainstream solutions fail to provide a solution (Intervention studies do not provide a solution, since different interventions did not lead to reduction in obesity parameters in the affected children) Very difficult to design interventions through biomedical models (Since the quantitative parameters of obesity are less well characterized and the definition of overweight may be faulty and empirical, biomedical models have failed to design effective interventions, which have been demonstrated in literature) Biomedical models fail to identify parameters (The quantitative parameters of obesity are less well characterized and the definition of overweight may be faulty and empirical as stated earlier) Results are inconsistent and failure indicated by rising childhood obesity (Studies have shown inconsistent results and failure of intervention measures to control rising childhood obesity. Moreover, biomedical models are inapt in mass behavioral modification and lifestyle alterations) Far less known are the effects of family-centric holistic approaches (Research in family-centric holistic approaches is virtually unknown specifically in the area of childhood obesity and thus the effects are putative) Inadequate literature and research (The very fact that there are inadequate researches and literature further strengthens the need for research) Points to need for research (This research may at least indicate, delineate, and justify factors that may be needed for further research in this area) Able to identify the gaps in current knowledge, so able to find out additional information (This research will be designed to identify new information, which will tend to fill the gaps in the current knowledge. The discussion above indicates that there is high probability that this research will be able to provide new information which may be clinically useful) Specialty being holistic medicine, would be able to interpret knowledge of biomedical research and modify and adjust them in the field of holistic medicine (Most importantly, this research has an objective of providing holistic solution to a biomedical problem, which is currently unknown, and this author being a holistic medical practitioner would be able to identify the relevant holistic medicine parameters of a biomedical area, which are thus far unknown) Increasing global burden of childhood obesity Currently inadequately addressed through existing healthcare frameworks (The current healthcare frameworks have failed to address the problem of childhood obesity neither in the curative nor in the preventive fronts) Mostly bugged with failures (Most studies indicated failures in interventional measures) Demonstrable gaps in the service provisions (Since the relevant details of intervention measures are unknown, the service provision is fragmented and bugged with gaps. Most cases failure to achieve and sustain behavioral changes) No specific guidelines (No specific guidelines are available for management) More positive health behavior profile is essential for health promotion and disease prevention in childhood obesity (Literature indicates necessity of health promotion through accomplishment of positive health behavior profile, which will lead to sustained prevention) Important to identify the fact that childhood behaviors are strongly influenced by parents and family behavior profile (Behavioral and holistic studies indicate the parental and familial influence on childhood behaviors, which may continue into the community) Failure to recognize these possibly the cause of failure (Biomedical model is ignorant about the ways to effect behavioral change in children and it fails to recognize these factors relevant to a family and hence is unaware of the ways) Needs research and interpretation of parameters in the holistic medicine viewpoints (Holistic medicine on the contrary accepts the fact but has great paucity of research hence unable to discern, identify, and interpret these parameters) Holistic approach may improve acceptability of interventions (In contrast to clinic based biomedical approach, family based holistic approach may be more acceptable to the subjects) Improved acceptability may improve outcomes of interventions (Improved acceptability of evidence based interventions and improved compliance improve the outcomes) Need to promote physical activity and healthy eating behaviors in children and adolescents (Studies have conclusively indicated the positive effects of healthy eating behavior and regular physical activities as a lifestyle behavior definitely produce positive results, and hence these need to be promoted) Physical activity and dietary behaviors are matters of personal space, does not belong to the current framework of biomedical health interventions (However, biomedical models fail to implement these since physical problems in that model are viewed as related to organs, rather than to the person. On the contrary, these lifestyle behavioral patterns are matters of personal choices; this biomedical model is not suitable for designing interventions) Matters of personal space largely belong to family environments (For children, the matters of personal and behavioral choices are influenced by environment where they grow, and the family provides the maximum of that.) These may be the causes of failures and increasing burden of childhood obesity. (Inability to implement interventions through families may be the main causes for failure to achieve sustained behavior changes through life courses) The Holistic Approach Theory of healing and the related quality of life theories Return of human to natural conditions for achievement of health Provision of resources for existential healing Awareness, care, acknowledgement, and acceptance Ability to letting go negative beliefs and attitudes (All these above points are the mainstays of the theoretical framework of holistic medicine and are very important considerations in effecting sustained behavioral changes in human beings. It is to be accepted that the strongest influence on human behavioral patterns is from within and the best impetus arises from awareness about self that leads to self confidence in effecting a positive behavior. This is a matter of change and matter of establishing a new belief) Need to beget a philosophical change at personal level (This means there would be a need to accomplish a philosophical change where the individual fully acknowledges the need of change and is involved himself in making the change) Personal philosophical changes begin best at families, supported by families (For children, family is the stage for such changes, since family not only shows the pathway through action, it provides a helpful environment and supportive atmosphere to ward off the frustration from failures) Existential approaches aligned to nature are rooted in families, not in clinics (Clinics in contrast fail to provide this, since persons can actually understand the meanings of their existence best at homes) Holistic medicine may be the ultimate solution (The all pervading nature of this scenario indicate fragmented organ centric approach would mostly fail, and the best option could be holistic or at the worst biomedical approach with holistic elements in it) Implementation is best done by the affected population not by healthcare providers (Contrary to the framework practiced in biomedical approaches, the contact time with the healthcare providers may prove to be very inadequate. However, when the affected or at risk population takes ownership to beget changes in themselves, there would be nothing like this, since this change occurs from within) Decision to change is the best driver, rather than promotion of a change in behavior (Behavioral changes may be promoted but that does not ensure change, however, when a person decides to change behavior, that becomes the best possible promotion.) Need Practical application of this theoretical framework (Although theoretically this sounds very good and easy, norms of practical applications are to be designed) Health behaviors are determined strongly by various social, economic, and environmental circumstances (The different denominators of health behaviors are inherent in social, economic, and environmental circumstances, which add to the parameters that need to be controlled in order to implement a change in behavior) These circumstances are prevalent in the families and in the community (For evident reasons family and community provide the different scenarios and circumstances relevant to any specific and intended behavior) Health literacy is an important pathway to build up a personal and behavioral approach (To change a behavioral pattern in the desired way, the most important factor is information that leads to awareness, and health literacy on any particular health problem can sow the seed for the need for personal behavioral changes) These approached are more effective if practiced together in family environments leading to lasting and sustained impacts (Research has shown that these changes are best effected in groups, and thus feasibility to practice a health behavior in the family is expected to produce the best outcome, and other studies have shown lasting and sustained impacts of health behavior and lifestyle changes in families) Action occurs at cognitive levels in individuals leading to permanent positive changes (Behavioral science also indicates that permanent positive changes in individual behaviors means a cognitive change) In children may lead to life-long process of learning, genesis of health competencies and positive health behaviors, development of specific knowledge and cognitive skills, and creation of self attributes (The above factors in children may initiate a process which may change the course of life through process of learning, genesis of health competencies and positive health behaviors, development of specific knowledge and cognitive skills, and creation of self attributes, hence it indicates changes in beliefs and behavior in a permanent note) These need to be continuously supported and facilitated by the family members (The support of the family is needed in every step of these changes) The Other Side of the Story Definite biomedical interventions have failed to achieve any success in controlling childhood obesity (It has been indicated in research that biomedical interventions have been fraught with failures) Trebling of the prevalence of these conditions in the last 20 years (Which is indicated by the rising prevalence, incidence of childhood obesity) Many children are affected with the negative health consequences of obesity, such as, hypertension and diabetes (This is a problem that needs to be intervened seriously and aggressively due to the negative consequences of future life and its complications) Negative community practices are facilitated if the cognitive and behavioral changes are not initiated (Ignorance about the factors and health illiteracy may lead to negative community and family practices, which may intervene but unable to effect cognitive changes strong enough to initiate lifestyle and behavior modification) Lower academic performance, tardiness, absenteeism, chances of detention, and decreased life span (Apart from future effects in adulthood, childhood obesity has been reported to be associated with many negative consequences in childhood compromising the quality of life with very negative effect on life course) High prevalence of depression, lower self-esteem, higher social isolation, and increased stigmatization (The productivity in childhood is affected grossly by the psychosocial implications of obesity) Family interventions are not suitable in biomedical models (Unfortunately, the biomedical models fail to consider the family angle in the intervention design) Family Intervention Holistic Way Great paucity of research in this area both in the mainstream and holistic clinical medicine (Although holistic approach sounds great, research in this area is missing and knowledge about the different covariates of this problem is extremely incomplete) Although the theoretical parameters are delineated in holistic medicine, the practice guidelines have not been developed (Holistic medicine has delineated the theoretical framework successfully; however, paucity of research specifically focused on childhood obesity led to failure of development of practice guidelines) Holistic practitioners need practice guidelines and practice parameters in obesity control (To be able to implement these principles, practice guidelines are necessary) Home holistic interventions in diet and behaviour modification could be helpful in reducing childhood obesity and overweight rates (Derived from theoretical principles, home based family oriented holistic interventions have higher possibility to be effective in controlling the problem of childhood obesity and overweight rates, since children's behavior modification is best accomplished and supported in families) Holistic medicine approach can be applied in the home environment where parental involvement may prove to be efficacious (As indicated earlier, the parental involvement and influence in behavior change can be taken advantage of at homes) Thus details of these interventions are not known mainly due to lack of evidence from research (Of course, how these can be done is best guided by research, which is lacking) Research focused at family interventions is the need of the hour (And thus such research is indicated) Rationale of Outline Childhood obesity has largely been attributed to excessive energy intake and reduced physical activity (The main physiological reasons are excessive energy intake in contrast to energy expenditure) Major reason for failure of interventions directed to reduced energy intake and increased energy expenditures in controlling childhood obesity is failure to modify family attitudes and environments (Research has indicated that control of these two main factors is very difficult at the personal level only through promotion since family attitudes and environments strongly contribute to these) Better understanding of these children's lifestyles from the family points of views may have the clue to such problems (Moreover, intervention strategists might have failed to understand these points from the scope of the family in modification of childhood health behavior patterns) Family oriented interventions within the modern affluent societies may be designed (Thus the need may be an evidence-based design of family oriented intervention) Main intent would be permanent behavioral modification at cognitive levels and practiced by whole family thus changing the community behavioral patterns (Where the goals would be to achieve community behavioral alterations through family modifications at cognitive levels leading to a life course change, which complies with a holistic health model) Effective Interventions Effective dietary treatment would need a thorough analysis of their nutritional status, eating habits, methods of nutritional habits, and other environmental factors such as community factors, peer practices and influences, availability of resources such as food and opportunity of physical activities (Research has indicated the parameters of effective dietary interventions many of which originate in the families) Simple obesity in children is closely related to environmental factors such as parental level of education, familial inclination to obesity, and other related health habits and influences by peers and cultural impacts. (There are known environmental factors that may be prevalent in families and communities and cultural heritage and thus may be controlled by families best) Specific dietary intervention with low energy diet and food elements with low glycaemic index has an element of acceptance by the parents and also the children (Parental and familial dietary habits are known to influence children) Physical exercises and leisure practices (Physical activity and inclination to leisure practices are co-dominated by parents and families and may be formed by the families) Environment Control Main reason for increasing prevalence of obesity in childhood is their environment that fosters obesity (Interventions would mean environmental control) Environments promote high intake of energy and sedentary habits with low physical activities (Environment influences diet, leisure, and practices related to physical activities) Family status is an important parameter, and affordable food may impact strongly the diet consumption by the family (Family socioeconomic status and awareness decide family food) Family access to leisure facilities (Family locality decides access to leisure facilities involving physical exercise) Explain the rationale for your choices in the literature review Not known what interventions are suitable in the family environment (Suitable family environment research is not available, and the parameters for interventions are needed to be known) Explore these unknown factors that may contribute to childhood obesity which may as well have its origin in the family environment (Factors that originate in family environments may be causative) Limited knowledge on dietary pattern that a family pursues, there may be a whole list of factors that may be associated this problem (Knowledge and awareness of family regarding obesogenic factors may need to be explored which may reveal many environmental factors that may be easily intervened) Rationale of Literature Review Need to add to the evidence base to this from the point of view of holistic medicine (Intervention must be evidence based) Most of these factors are inadequately explored, the knowledge is scattered, evidence is limited, and many factors may be unknown (Need for research has been indicated earlier) Need to know an appropriate design of the research (Literature review would indicate an appropriate design for the research proposed) Objective: Holistically oriented interventions (In order to establish holistically oriented family interventions) Literature Review Targeting multiple obesogenic covariates (Need to identify all possible factors and their interactions in childhood obesity) Solutions for disparate factors (Most of the factors are fragmented and so are the interventions) Family environmental control through a holistic approach (The target interventions would be the outcome and these would target control of family environment) Identification of existing family-centric approach (The gap in knowledge would be identified by knowing the existing family centric approaches) Analysis of these covariates and explore their relations with the holistic clinical medicine in order to determine their influence on childhood obesity (Analysis of the results and data would identify the covariates, their interaction and interrelation, influences, and modes to control them to design intervention) Possible Angles to be Investigated Role of supportive families in deployment of family interventions in the management of childhood obesity (Review of literature indicates the need to investigate the roles of families) Despite limited evidence about the effectiveness of these interventions (It must be kept in focus that these interventions have been proven to be ineffective) Holistic interventions may be expected to yield positive results in supportive family environments (The hypothesis suggests possibility of successful interventions through holistic means) Clinical intervention studies in childhood obesity indicated these interventions to be multidimensional (The most important reason for the above hypothesis is that holistic interventions are multidimensional, and previous research indicated need to explore multidimensional approaches as interventions against childhood obesity) Possible Approaches Health-centered lifestyle approach (Holistic approach is lifestyle oriented) Reduction of energy intake but maintenance of nutrient intake (Main objective is to design behavior that maintain nutrient intake but reduce energy intake) Reduction of sedentary leisure activities and increase in physical activities (The secondary objective would be to promote behavior that seeks physical activity and reduce sedentary leisure practices in the families) Active engagement of parents and family in children's behavior change processes through a supportive family environment (Supportive family environment and parental facilitation as promoting factors in these interventions) Achievement of gradually increasing small changes (Behavioral changes occur in the cognitive domain and hence dramatic changes are unrealistic and hence small changes incorporated within the life course could be the solution) Other Approaches Interventions are administered to groups (Group approach is known to be more effective in effecting behavioral changes) Role of social support (Behavioral changes are maintained by social support) Family approaches to effect behavioral changes (Ways to explore means to effect parental changes as initiators of behavioral changes in children, awareness may be the key) Long-term reversal of childhood obesity is difficult to attain (Difficult to sustain a behavioral change through promotion only) Key words derived from these concepts will serve as literature search terms (These concepts will provide key words that would be used to perform an exhaustive literature search from data sources through the use of Boolean logic with the use of "and", "or" or "not" staying focused to the research question and search performed under strict inclusion and exclusion criteria) Read More