The Prevalence of Obesity among Female School Children - Capstone Project Example

Research Project Grant 6486 Research Planning Application form DO NOT MIND THIS. THIS IS JUST A RE-SUBMISSION TO PLAGIARISM CHECKER IN ORDER TO CORRECT WRONG REPORT. MAJORITY OF INSTRUCTIONS IN THIS FORM WERE IDENTIFIED AS PLAGIARISM SUCH AS THOSE IN “Guidelines for Applicants”, INVESTIGATOR DETAILS and other forms below. GUIDELINES FOR APPLICANTS Research Project Grant 6486 Research Planning Application form 1. PROJECT TITLE (maximum 200 characters) Randomised Controlled Trial of lifestyle modification (physical activity and dietary modification) intervention to reduce high BMI equal or greater than the 85th percentile to the normal range between 50th percentiles to less than the 85th percentile in female from 6-8 in Arar, Saudi Arabia? 2. SIMPLIFIED PROJECT TITLE (maximum 80 characters) Effectiveness of a lifestyle intervention using RCT design to reducing high BMI of girls in Arar, Saudi Arabia Title Title University of Canberra, University Drive, Bruce, ACT 2617 ( Academic Centre) At 6 public schools in Arar, Saudi Arabia 8. PROJECT SUMMARY (maximum 1 page) The aim of this project is to test health and lifestyle intervention through Randomized Controlled Trial or RCT method. The subject of this RCT will be Saudi Arabian female children with age ranging from 6 to 8 years. The primary hypothesis is that lifestyle and nutritional interventions can positively alter children’s eating behaviour and increase physical activity resulting to reduced BMI in children. It is also hypothesized that children have little control over their environment thus strong parental support is necessary. The research plan is to conduct a Randomized Controlled trial involving 6 schools, female students with age ranging from 6 to 8 years in Arar, Saudi Arabia. Six schools will be selected and participants with approved parental consent form (see Appendix A) will be randomly selected to form two groups. One for intervention and the other is for control group. Their weight and height will be recorded at the start of the trial, monitored, and measured every 2 weeks until the end of the six months trial. The difference in the BMI level will determine if nutritional education and physically activity has an effect of obesity. The significance of this project is the fact the results of the RCT can help future interventions to develop appropriate approaches in reducing children overweight and obesity particularly in the Saudi Arabian region. Similarly, government entities such as the Saudi Arabian Ministry of Health and Ministry of Education to improve their strategies and create programs that can effectively promote healthy diet and active lifestyle such as inclusion of physical exercises in the school curriculum and encouraging parents to serve their children healthy foods. Moreover, result of this project can help government reduce health care spending through prevention of diseases commonly caused by obesity. 9. LAY DESCRIPTION (maximum 80 words) The project will conduct a 6 months Randomised Controlled Trial to determine if high BMI > 85% of female Saudi Arabian children, 6 to 8 years of age will be reduced to normal range. The reduction will be based on the result of BMI (measurement of body fat using height and weight) and Triceps skinfold or assessment of body fat using skinfold calipers 10.1 Background Background In the study conducted by Awatif Alam1 in 2008 regarding the prevalence of obesity among female school children in grades 4 to 6 in North West Riyadh, 14.9% of students were obese. This obesity was found not only inversely increased by age but also more prevalent (95%) in children belonging to affluent families. Other findings include 89.2 % of children doing some exercise but some 13.8% were still obese. Obese children are commonly those that are consuming fast food, soft drinks, and always watching television. The conclusion of the study points to the importance of school and family cooperation during intervention in matching the changes in social and cultural context. Although not intended for female school children, the Saudi Arabian-based study of Al-Hazzaa2 between 1988 and 2005 to find the prevalence and trends in obesity among school boys 6 to 14 years of age in the central region is reveals the significant increase in BMI, body fatness, and prevalence of obesity. The identified causes were low physical activities and excessive television viewing while education, research, and intervention were viewed as ways to treat and prevent childhood obesity. Causes of obesity in childhood include the interaction between several factors such susceptibility and environmental factors responsible for increased food intake and decreasing energy expenditure. These include consumption of energy-dense food, regular intake of sugar-sweetened beverages, sedentary activities such as watching television and playing computer games, parental and socioeconomic factors, ethnicity, lifestyle, and others3. Other study of obesity finds mean energy intake is 10% higher for school-aged children who drink soft drinks compared to those who did not. Similarly, sugar-sweetened drinks were found to increase risk of obesity in children. Children were also found taking fewer meals at home and prefer fried food and soft drinks to fruits and vegetables. In girls, less physical activity was linked to increase BMI while 2 hours or more of engaging in electronic media can increase overweight in schoolchildren by 70%4. Childhood obesity often tracks to adulthood along with adverse health effects such as type 2 diabetes, elevated blood pressure and dyslipidemia5. Study conducted by Bouchard et al.6 suggests that 40% of overweight children become obese adults while 15 to 20% of obese adults were overweight during childhood. Similarly, several studies show the impact of obesity not only in long-term physical health but also in subsequent self-esteem, social and economic characteristics. For instance, study of 370 overweight adolescents in 2000 shows that obese young women are less likely to marry; they often have lower income, and completed less schooling compared to non-obese women7. Moreover, while people tend to develop negative stereotypes of groups, obese children are often stigmatized and discriminated resulting to chronic stress, low self-esteem, internalized oppression, constricted social networks, unemployment, and poor health8. Childhood overweight and obesity prevention must not be harmful. According to O’Dea & Eriksen9 for instance, health education messages communicating the negative impact of obesity make children feel worse about themselves and this can lead to use of inappropriate and damaging weight control such as starvation, vomiting, laxative abuse, and cigarette smoking in order to suppress appetite. Many believed that the best defence against obesity is healthy diet and lifestyle change and these include an effective intervention and strong support from parents10. In studying the effectiveness of interventions used in the prevention and treatment of childhood obesity, several Randomized Controlled Trial or RCTs were reviewed by Wilson et al.11 in 2003. In health promotion, one RCT with 227 participants assessed the effects of using a classroom-based curriculum in reducing television and video tape watching, video game playing, and increasing physical activity and healthy food consumption. After 7 months, children in the intervention were found to watch less television and play fewer video games, they also have lower body mass index or BMI, less triceps skinfold thickness, and waist circumference compared to children in the control group. In terms of physical activity, one RCT with 310 participants conducted a 30 weeks exercise programme encouraged involving children with age ranging from 4 to 5. At the end of the programmes, results showed no significant difference between exercising children and those in the control group but prevalence of obesity decreased in all children groups. In three RCTs using family based intervention, result of the first RCT with 55 participants showed that stressing the importance of eating low fat and encouragement to take a low cholesterol diet and increasing physical activity has no statistically significant effect in terms of percentage of daily calories and fat. The second RCT with 26 families with non-obese children who had obese parents and randomized to groups that encouraged intake of fruit and vegetable and decrease intake of high/high sugar foods, showed significant reduction in the percentage of overweight in favour of parents in the increase fruit and vegetable group. In contrast, there is no significant difference in the percentage of overweight children. In the result of the systematic review conducted and presented by Kamath et al.12 in 2008, out of the 47 RCTs enrolling children and adolescents ages 2 to 18 years and assessing the impact of interventions in changing lifestyle behaviours and subsequent BMI levels paediatric obesity prevention programmes caused small changes in target behaviours and BMI levels. The RCTs reviewed by Littikhuis et al.13 concerning interventions for treating obesity affecting the physical and psychosocial health of children suggest that lifestyle programs reduced the level of overweight in children 6 to 12 months after the program with or without drug interventions. 10.2 O---DELETED The research intends to show the importance of RCT intervention in reducing high BMI particularly in female with age ranging from 6 to 8 residing in Saudi Arabia; The result is expected to help other future interventions to determine the most appropriate approach in childhood obesity prevention. Moreover, related government entities can use the result to develop programmes that will promote healthy diet and active lifestyle among schoolchildren. 10.3 Research design and methods Study objectives The objectives of this project is to conduct a Randomized Controlled Trial to find out whether health and lifestyle intervention can help prevent the development of overweight and obesity among female school children 6 to 8 years of age. Specifically, this RCT aims to: Identify the changes in BMI levels in the intervention group Compare BMI levels of intervention groups with BMI’s of those in the controlled groups. Identity factors that reduced obesity development Study the possibility of maintaining healthy eating habits and physical activity among school children aged 6 to 8. Analyse the interaction of factors contributing to weight increase such a parental obesity, culture and weather condition. Identify barriers in the implementation of the intervention Hypothesis Female schoolchildren assigned to intervention group are expected to have lower levels of BMI, consume more fruits and vegetables, physically active, and more confident after 6 months. Schools selection criteria The research project will identify the most appropriate school for the study in the province of Arar, Saudi Arabia. These are schools with female schoolchildren with age ranging for 6 to 8 years. All participants with parental consent will be divided into two groups. One will form the experimental group while the other will serve as comparison or control group. Participants, recruitment and randomization In total of 6 schools with 60 participants (computed sample size) with consent, comes from different socioeconomic background and with age ranging from 6 to 8 years will be recruited and randomly selected to form part of either BMI intervention or normal BMI control group. The number of female student participants, only those with parental consent, will be assigned to these groups after their weight and height are taken and recorded. The BMI Intervention Group will undergo nutritional education and physical activity program such swimming and walking. The project will keep an activity log of the BMI intervention group. The RCT intervention will last for 6 months with weight measurement every 2 weeks. Selected participants who are eligible for the study will be asked to sign a consent form. A consent form (see Appendix A) contains important information about the study such as information about the research, aims, outline, participation requirements, and ethical concerns such as privacy and consent. Participants may be also required to provide their contact details in case any discrepancy is found during data analysis. Throughout the research, participants will not be referred to through their names but through code numbers designed to protect their privacy. All RCTs involving children requires a signed consent form from the parent or guardian of the child. This is to protect them from any harm or discomfort associated with the research particularly in RCTs requiring physical or psychological examinations14. Data Collection and Analysis In a private room, weight and height of participants wearing light clothing and without shoes will be measured and use the data collected to calculate BMI levels. A trained person working for this project will conduct each measurement. To ensure accuracy of weight measurement, a Seca digital personal weighting scale will be use. Seca can measure weight up to the nearest 0.1kg thus very suitable for this research. Similarly, the height will be measure by a Seca Mechanical Measuring Rod as it also accurate as the weighing scale. While standing erect and looking straight ahead, a participant’s height will measured to the nearest 0.1 cm. BMI levels is the ration between weight and height and since the BMI values must be translated into a percentile suitable for a child’s sex and age, the research will additionally use BMI-for-age growth charts for added accuracy. Finally, those with BMI equal or above the 95th percentile will be regarded as obese. Inclusion and exclusion criteria The participants must be at least 6 years of age and not over 8 years old, overweight or obese at the time of the trial, resident of Arar, and with parental consent. Female students with chronic health problems that can affect their height, weight, eating habits, and physical activity are excluded but are welcome to observe and receive health-promoting information. Sample size The sample size is determined using an online sample size calculator with a confidence level of 95% and a confidence interval of 4. The female students’ classroom population is computed using an average of 11 female students (50% of 22, the average classroom population). The total number of female participants is 66 (6 schools x 11) while the sample size calculated is 60 female schoolchildren. Quality Control In order not to affect the quality of intervention, the recruitment and administration process will follow the ethical guidelines stated in the Australian National Statement of Ethical Conduct in Human Research. Data collection will be conducted in the most accurate manner possible using BMI technique. Participants’ baseline and subsequent body mass will be measured by dividing body weight in kilograms by height in metres squared. BMI is very useful particularly when investing differences between groups while height and weight can be taken with considerable degree of accuracy using widely available and easy to operate equipments. Outcome Measures The primary outcome measure in terms of overweight and obesity is reduction of BMI levels and decreased triceps skinfold measurement in mm. Since BMI 85th to 94th percentile is considered overweight and BMI 95th to 100th percentile is obese, BMI below from 5th to 84th percentile is considered healthy weight. Similarly, triceps skinfold measurement exceeding 15 mm is obesity15 then measurement below 15mm is an indication of low body fat. Limitations and Strengths of Approaches and Possible Alternatives Randomized Controlled Trials are bias free when conducted correctly, as randomization eliminates such inconsistencies. However, the very people implementing the research such as human error in measurement and analysis can affect RCTs. The most appropriate way to avoid this is to minimize human interaction by using computers to manage randomization, data processing and analysis, and reporting. 11. SELECTION CRITERIA (maximum 2 pages) Overall quality and relevance to improving human health 11.1 Scientific quality of the proposal The research will be of significance to the scientific community, as those in the field of children care and health will benefit from the result of this research. For instance, if this RCT finds that nutritional education and physical activity such as regular walking and swimming can indeed reduced BMI levels then practitioners of children’s health and care will have some point of reference when dealing with children’s nutritional and physical needs. Moreover, factors that were identified in this research such as causes of obesity and barriers to intervention can help practitioners create a better approach. In terms of accuracy and bias, the method that will be used is known to eliminate bias through randomization. In terms of validity and reliability, accuracy is ensured through comparison groups and outcome measures employing widely accepted technique such as BMI levels and triceps skinfold measurement. Contribution to knowledge in cultural context The research’s primary contribution to knowledge is the processes used and the result of the Randomized Controlled Trial. However, the impact of this research to children’s health is undoubtedly beyond mere realization of aims and objectives as successful prevention of obesity in childhood leads to better life in adulthood due to absence of chronic diseases associated with overweight and obesity. Moreover, since data was taken directly from Arar population, it can be applied to other regions of Saudi Arabia thereby eliminating similar cultural and environmental health causes of obesity and improving health of children all over the Kingdom. According to Brownell & Kaye16, although childhood obesity contributes to risk for coronary heart disease, growth hormone inconsistencies, hypertension, and hyperlipidemia, it is the psychological and social hazards of obesity that is more unbearable. The result of the research therefore is not only contributing to improvement in children’s health but help to avoid emotional and social difficulties. Innovation The research is actually not an innovation per se; the innovation comes from bringing the benefit of RCT intervention to Arar and the courage to confront overweight and obesity problems of schoolchildren as early as 6 years of age. Quality of the design and methods Randomized Controlled Trials are considered “gold standard”17 for evaluating health care interventions. However, this does not necessary mean that all RCTs are of high quality because some of them are with poor methodological quality and bias in their estimates of the intervention outcome. For this reason, the research will make sure that the power of randomization remains intact throughout the study by distributing variables among all treatment arms. The variation in the distribution arms according to Bhandari18 is responsible for biased outcome and over or underrepresentation of the true treatment effect. Availability of resources, skills and experience of the investigators Although with limited experience, the chief investigator of this research is committed to this project and aware of the power and limitations of research methodologies that will be use for the intervention. Through careful attention to details, the chief investigator hopes to meet the design requirements and complete this research successfully. 11.2 Coherence of the program Establishing the role of RCT intervention in reducing BMI in children Randomized Controlled Trials is a widely used intervention technique particularly in health in which patients are randomly allocated to different treatment arms of the study19. For this reason, randomized trial gives the best evidence of effectiveness20. The key feature of RCT is randomization of participants assigned to intervention or control arm and its primary advantage is concealment or blinding and group balance except for treatment received. Blinding prevent selection bias21 by keeping participants, health care providers, data collectors, and outcome assessors unaware of the assigned intervention21. For this reason, RCT intervention can very useful in assessing the effects of nutritional education and physical activity to schoolchildren age 6 to 8 and currently studying in 6 schools in Arar, Saudi Arabia. Appropriateness of the selected method of study The appropriateness of the selected method of study primarily comes from the fact that RCTs are very useful method of intervention particularly in health care. RCTs divide participants into groups randomly and use blinding technique to avoid bias reporting. The study needs to know the effectiveness of RCTs in reducing high BMI in children thus the whole process requires two set of participants (one in the intervention group while the other is assigned to control group) for outcome comparison. RCT will make sure that variations in the level BMI are measured correctly while the impact of nutritional education and physical activity will be fair and accurate. Practical application of findings Undoubtedly, the practical application of findings will be in area of obesity prevention in female school children aged from 6 to 8. However, the application is not necessarily limited to this age or schoolchildren since some of the factors leading to child obesity are believed to be present in other age groups. 11.3 Re-DELETED Although the research will be conducted in Saudi Arabia, the findings will be useful in Australia in the sense that overweight and obesity in children is not limited to Saudi Arabia but a global concern. Although with different cultural background and environmental concern, the variation in obesity causes and treatment is small. For instance, excessive television and consumption of sugar-sweetened drinks is a universal cause of overweight and obesity while eating fruits and vegetables is a universal treatment. More importantly, the success of RCT in the determining the true impact of nutritional education and physical activity in reducing obesity in children can encourage other groups in Australia to use RCT as their primary method of research. 11.4 DELETED The results of the research hoped to influence decision-makers into pursuing more realistic health programs for children particularly those at a very young age that may be affected by overweight and obesity. Similarly, the result of this research may influence education initiatives and rethink the role of educational institutions in terms of children’s health and well-being and prioritized activities and programmes associated with healthy eating and active lifestyle. Scientific Standing of the Investigators – ALREADY INCLUDED IN SECTION 11.1 LAST PARAGRAPH 11.5 Funding 11.6 Considering the cost associated with RCT implementation, travel expenses, and other resources such as equipments for measuring BMI and analysing data, the project is undoubtedly short of resources. Funding is therefore critical to the success of this project thus it is hopeful that the University of Canberra will understand the need and grant the project financial assistance. However, since funding is so important to this project, it may source out and seek alternate grants from the Saudi Arabian Ministry of Health or Ministry of Education. It might also ask some private companies or individuals who may be interested in funding such endeavour. If all fails then this project will be cancelled. DELETED 11.9 The market ability of this project comes from the fact the result contains important information regarding the effectiveness of RCT intervention in reducing BMI. These include the right food for children and the physical activity required which is potential useful for commercial businesses who wants to venture in healthy food production or exercise equipment for children. Existing food manufacturers may be also interested in the result particularly when their products greatly contribute to overweight and obesity (i.e. Pepsi or Coke may be interested to know that soft drinks are the biggest contributor of fat in children and use the data from the research to manufacture “healthy” soft drinks for children. Consumer Involvement 11.10 Consumer Involvement The relevant institutions in both Australia and Saudi Arabia will be notified about this research project. This is to provide these institutions with knowledge about the project and the relevance of using RCT in health interventions involving female children with high BMI levels. These institutions include the Saudi Arabian Ministry of Health and Ministry of Education, Diabetes Australia, Juvenile Diabetes Research, Department of Health and Ageing, The Heart Foundation, and others who have been involved in fighting diabetes and other chronic diseases caused by obesity. 12. 1. Alam W. Obesity among female school children in North West Riyadh in relation to affluent lifestyle. Saudi Med J 2008, Vol. 29 (8): 1139-1144 2. Al-Hazzaa H. Prevalence and trends in obesity among school boys in Central Saudi Arabia between 1988 and 2005. Saudi Med J 2007. Vol. 28 3. Korbonits M. Obesity and Metabolism. Karger Publshers. 2008: 89 4. Kiess W. Obesity in Childhood and Adolescence. Karger Publishers. 2004: 54 5. Dietz W. Clinical Obesity in Adults and Children. John Wiley & Sons. 2009: 433 6. Bouchard C, Bray G, & James W. Handbooks of Obesity: Etiology and Pathophysiology. CRC Press. 2003:118 7. Pitombo C. Obesity Surgery: Principles and Practice. McGraw Hill Professional. 2008: 398 8. O’Dea J. & Eriksen M. Childhood Obesity Prevention: International Research, Controversies, and Interventions. Oxford University Press. 2010: 18 9. O’Dea J. & Eriksen M. Childhood Obesity Prevention: International Research, Controversies, and Interventions. Oxford University Press. 2010: 32 10. Stern J. & Kazaks A. Obesity: A Reference Handbook. ABC-CLIO. 2009: 112 11. Wilson P, O’Meara S, Summerbell C, & Kelly S. The Prevention and Treatment of Childhood Obesity. Qual Saf Health Care 2003: 12:65-74 12. Kamath C, Vickers K, Ehrlich A, & McGovern L. Behavioural Interventions to Prevent Childhood Obesity: A Systematic Review and Meta-analyses of Randomized Trials. J Clin Endocrinol Metab. December 2008, 93(12):4606-4615 13. Littikhuis O, Baur L, Jansen H, & Shrewsbury V. Interventions for Treating Obesity in Children.Cochrane Database of Systematic Reviews; 2009 (1); Art. No. CD001872 14. Solomon P, Cavanaugh M, & Draine J. Randomized Controlled Trials: Design and Implementation for Community-Based Psychosocial Interventions, Oxford University Press; 2009: 31 15. Timby B. Fundamental Nursing Skills and Concepts. Lippincott Williams & Wilkins; 2008; 299 16. Brownell K. & Kaye F. A school-based behaviour modification, nutrition, education, and physical activity program for obese children. The American Journal of Clinical Nutrition 35: 1982; 277-283 17. Bowling A. Handbook of Health Research Methods: Investigation, measurement and analysis, McGraw-Hill International. 2005; 85 18. Bhandari M. Evidenced-based Orthopedics. John Wiley & Sons. 2012; 8 19. Bhandari M. Evidenced-based Orthopedics. John Wiley & Sons. 2012; 9 20. Thornicroft G, Szmukler G, Mueser K, & Drake R. Oxford Textbook of Community Mental Health. Oxford University Press; 2011; 300 21. Bowling A. Handbook of Health Research Methods: Investigation, measurement and analysis, McGraw-Hill International. 2005; 86 22. Gad S. Clinical Trials Handbook. John Wiley & Sons; 2009; 508 13. DELETED 14. DELETED BUDGET: Amount requested from grant: All cost below Item Description Cost Staff NHMRC Personnel Support Package 1 Technical Support – non-graduate personnel $48,250 6 months or 24 weeks – $24, 125 Equipment Seca Medical 703 Digital Column Scale for measuring BMI $585 Seca 216 Height Rod $95 Maintenance and Consumable Items Travel Cost (Airfare Round Trip) $3,814 Stationery Cost $500 Technical Equipment $1000 Support Services $500 Laboratory Fees n/a Phone Charges $150 Total $30, 769 14.2 Justification of Budget (Maximum 1 page) The amount requested is critical because personnel, equipment, and services are very important to the success of this project. For instance, precision equipments for measuring weight and height are essential to the accuracy of the calculated BMI levels of participants. Similarly, it is not possible to organize and take proper measurement without the help of staff or personnel. Moreover, since the Randomized Controlled Trial will occur in Arar, Saudi Arabia, the chief investigator needs to travel by air and pay for the round trip ticket from Canberra to Arar. Documentation is also critical to this project thus stationeries, technical equipment such as computers, printers, and others are necessary. Although there is no laboratory expenses, there is still a need for support services that would ensure proper functioning of technical equipments. The University of Canberra will benefit from the support and funds that it will provide because the health benefits that may be acquired from the result of this project will be credited to the University. In case no funding is granted, alternative funding from the Ministry of Health or Ministry of Education of Saudi Arabia may be requested. However, since I am a proud student of University of Canberra and planning to finish all educational requirements in this institution, the support and commitment of the university to the welfare of children in Arar is much appreciated. 18. DELETED DELETED As this research will be conducted in Arar, Saudi Arabia where ethical guidelines are not yet established, the research will follow the National Statement on Ethical Conduct in Human Research 2007. This is in the belief that the researcher is at present part of Australian Institution and accountable to the provisions stated in the country’s ethical guidelines for human research. Ethics application will be submitted for approval before the research proceeds with its initial activities. The sample participant for this research will be randomly selected and those that will be selected will have to give their informed consent and submit an approved parental consent form to ensure that both students and parents are well aware and willing to participate in the 6 months study. In addition, RCTs and other method of research can greatly impact the privacy of an individual or generate a negative psychosocial behaviour particularly for children that are already experiencing discrimination. These issues will be address by applying the most appropriate approach based on the Australian guidelines for ethical conduct. 18.1 DELETED N/A 19. CERTIFICATION Insert the current University of Canberra Faculty of Health assignment cover sheet here. APPENDIX A. Consent Form UNIVERSITYOF CANBERRA Informed Consent Form for Parents of Young Girls Participating in the Nutritional Education and Physical Activity Research Name of Principle Investigator :_________________________________________________ Name of Organization :_________________________________________________ Name of Sponsor : Name of Project : Effectiveness of a lifestyle intervention using RCT design to reducing high BMI of girls in Arar, Saudi Arabia Part I: Information Sheet Introduction I am _______________________ , a student of University of Canberra doing a research that may help reduce overweight and obesity problems in this community. In this research, our team will talk to your children and measure their weight and height. It is an important ethical requirement for a research to ask permission from both participants and their parents. Please take time to consider our request and study the possibility of your child’s participation. You can give us a call for anything you may want to ask about the research. Purpose There seems no study conducted regarding children overweight and obesity in this region, which in our research is very important to the well-being of children. This research will have your children as participants to a Randomized Controlled Trial intervention technique and benefit from the nutritional education and physical activity program that our team will implement. Type of Research Intervention Randomized Controlled Trial Selection of Participants Participants are overweight or obese schoolchildren with age ranging from 6 to 8 years and willing to learn nutritional education and participate in physical activity such as walking and swimming. Voluntary Participation We know the it is difficult to decide when it involves your children thus you can say no if you feel that our research is not suitable to your child. However, we will very thankful if you agree since this research will not only benefit children in this community but every children in the world in the near future. Procedure In a private room, weight and height of participants will be measured. A trained person working for this project will conduct each measurement. Duration The research duration is 6 months. Initial measurement of weight and height will only take a day or two while succeeding measurement to assess participants development will be every two weeks for the next 6 months. Confidentiality The research team will not share any information about your children. The data that will be collected is confidential. We will assign codes to each participants rather than using their names as reference. Right to Withdraw Your children can stop participating anytime they want. Contact Person for this Research You may contact the head researcher in this location and number___________________________________ Read More

Study conducted by Bouchard et al.6 suggests that 40% of overweight children become obese adults while 15 to 20% of obese adults were overweight during childhood. Similarly, several studies show the impact of obesity not only in long-term physical health but also in subsequent self-esteem, social and economic characteristics. For instance, study of 370 overweight adolescents in 2000 shows that obese young women are less likely to marry; they often have lower income, and completed less schooling compared to non-obese women7.

Moreover, while people tend to develop negative stereotypes of groups, obese children are often stigmatized and discriminated resulting to chronic stress, low self-esteem, internalized oppression, constricted social networks, unemployment, and poor health8. Childhood overweight and obesity prevention must not be harmful. According to O’Dea & Eriksen9 for instance, health education messages communicating the negative impact of obesity make children feel worse about themselves and this can lead to use of inappropriate and damaging weight control such as starvation, vomiting, laxative abuse, and cigarette smoking in order to suppress appetite.

Many believed that the best defence against obesity is healthy diet and lifestyle change and these include an effective intervention and strong support from parents10. In studying the effectiveness of interventions used in the prevention and treatment of childhood obesity, several Randomized Controlled Trial or RCTs were reviewed by Wilson et al.11 in 2003. In health promotion, one RCT with 227 participants assessed the effects of using a classroom-based curriculum in reducing television and video tape watching, video game playing, and increasing physical activity and healthy food consumption.

After 7 months, children in the intervention were found to watch less television and play fewer video games, they also have lower body mass index or BMI, less triceps skinfold thickness, and waist circumference compared to children in the control group. In terms of physical activity, one RCT with 310 participants conducted a 30 weeks exercise programme encouraged involving children with age ranging from 4 to 5. At the end of the programmes, results showed no significant difference between exercising children and those in the control group but prevalence of obesity decreased in all children groups.

In three RCTs using family based intervention, result of the first RCT with 55 participants showed that stressing the importance of eating low fat and encouragement to take a low cholesterol diet and increasing physical activity has no statistically significant effect in terms of percentage of daily calories and fat. The second RCT with 26 families with non-obese children who had obese parents and randomized to groups that encouraged intake of fruit and vegetable and decrease intake of high/high sugar foods, showed significant reduction in the percentage of overweight in favour of parents in the increase fruit and vegetable group.

In contrast, there is no significant difference in the percentage of overweight children. In the result of the systematic review conducted and presented by Kamath et al.12 in 2008, out of the 47 RCTs enrolling children and adolescents ages 2 to 18 years and assessing the impact of interventions in changing lifestyle behaviours and subsequent BMI levels paediatric obesity prevention programmes caused small changes in target behaviours and BMI levels. The RCTs reviewed by Littikhuis et al.13 concerning interventions for treating obesity affecting the physical and psychosocial health of children suggest that lifestyle programs reduced the level of overweight in children 6 to 12 months after the program with or without drug interventions. 10.2 O---DELETED The research intends to show the importance of RCT intervention in reducing high BMI particularly in female with age ranging from 6 to 8 residing in Saudi Arabia; The result is expected to help other future interventions to determine the most appropriate approach in childhood obesity prevention.

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