Fundamental Intervention To Minimise The Risk Of Obesity
Childhood obesity in England as a whole is increasing and is a significant problem facing, a National Health Service (NHS) survey estimates that 28% of children aged 2 to 15 in England were overweight or obese in 2016. Research shows if a child has at least one obese parent, they are around three times more likely to be obese than a child with no obese parents (Yee et al., 2017). Parents play a significant role in providing food and activity to their children, but for a variety of reasons they may not promote the healthiest choices. Valerio et al. (2018) discovered that parents and children either have inadequate knowledge of obesity and its severity or no knowledge at all, this suggests a lack of knowledge about child obesity. Rabitt and Coyne, (2012) says nurses need to provide guidance and lifestyle education whenever they are in contact with service users. Working with the family of the child is important as it will help nurses to recognise misunderstandings that families have about: exercise, feeding, and health issues (Glazebrook, 2016).
The aim of this essay is to meet a specific learning need which has been highlighted in the practice document essential skills. The specific learning need which needs to be developed is discussing sensitive issues in relation to public health and recognising the impact of obesity on their future health. The essay will explore and highlight the factors parent have that contributes to obesity. This essay will critically analyse Burton et al. (2019) and Lidgate et al. (2018) primary research studies alongside other sources of the most up-to-date evidence available to correctly address childhood obesity and nursing intervention that improves health outcomes. The Rolfe, Freshwater and Jasper (2001) Reflective Model will also be used to critically reflect on the findings from the evidence presented to change and improve practice.
I spent time working in a variety of fields as a student nurse. These include: hospitals, schools, and community. During my time in practice I have encountered children and young people who are obese in each of these areas. This is a topic that makes me feel uneasy to discuss as a student nurse and my rationale of where I found a void in my practice emerged from a problem that occurred in a clinical area that some nurses did not refer overweight patients to a weight management program in the community. The nurse’s main worries about not referring the child or young person was the assumption that another professional may have already done so, it seemed that they felt uncomfortable raising the subject of’ being overweight, as they may perceive it to be stigmatising and fear it may jeopardise their relationship with parents. I was concerned about the possibility that patients that are obese might not receive adequate treatment and I was also interested in exploring the parent’s response when encountered.
Stegenga et al. (2014) illustrated an absence of health promotion awareness as an additional barrier to successful health promotion and obesity management. This was confirmed by Kable et al. (2015)’s study, which found that most of the nurses they interviewed were unaware of best practise recommendations for weight management. I also found that nurses did not feel comfortable and had substantial time constraints whilst being out in practice, in line with these results, these studies found that nurses in action were unaware of current guidelines and lacked cultural awareness in obesity management.
Focusing solely on overweight and obesity leads to a victim-blaming mindset, and numerous studies indicate that overweight patients are on the receiving end of discriminatory practises. Discrimination and shame frequently occur in overweight patients who may also be considered non-compliant, lacking self-control and having a behavioural problem can lead to its own issues, such as excluding overweight patients from health care, which can lead to missed appointments for fear of embarrassment or coercion. This is a big worry for me and really inhibits my practice I will critically analyse and reflect upon this, to ensure I continue to develop my professional knowledge and skills base (Nursing & Midwifery Council (NMC), 2018).
Burton et al. (2019) research study undertook public health programmes; To give assistance to families living in the most deprived areas with the highest rate of obesity. This study’s findings offer interesting insight into the factors affecting participant participation in a support program for childhood obesity. The authors make realistic suggestions on how in future efforts to improve implementation and parent participation. Ethnographic study, which included field observations within the children’s centre setting is appropriate for the methodology and thematic analysis was applied correctly. According to MacLeod, (2016) Ethnography allows researchers to obtain an in depth understanding of a phenomenon by immersing themselves in a setting and attaching meaning and interpretation to findings. The strength of this method is that it allows researchers to collect information directly from the source (Parahoo, 2014). Conversely, Bourbonnais, (2015) states main problem dealing with validity may arise with ethnography, unlike another research where the researcher can maximally control external variables, the ethnographic research does not have this facility as the research is carried out in natural setting and due to the long time period of observation results may not be reproducible. To overcome this, Burton et al. (2019) study ethnographic observations was assigned to one researcher, a second researcher undertook observation in the first centre, both researches attended an advanced training course in doing ethnography prior to commencement of the study, this enhances the credibility of the study.
Lidgate et al. (2018) phenomenological study explored perceived reasons behind the relationship between informal childcare and childhood obesity and delivery strategies for preventing obesity in those children. Lidgate et al. (2018) findings do not seek to be generalisable but the study was credible due to the appropriateness of the methodology and the thematic analysis being correctly applied. The findings highlighted that education targeted towards informal carers will help them support the parents, also to prevent the risk of obesity in their child’s care. To carry out this study, Four in-depth focus groups with a total of 14 participants. This helps the interviewer to collect reliable data as the dialogue is facilitated and discussed with a specific topic that keeps the discussion focused on the topic in question. Patton, (2015) explains that using focus groups encourages interaction between participants. This interaction allows the researcher to elicit people’s understandings and views, or to explore how these are advanced in a social context. The strength of this type of study is that the researcher gets instant answers to some of their questions (Parahoo, 2014). However, Holloway & Galvin, (2016) states bias may arise because of selection of the study population. To conquer this Lidgate et al. (2018) recruited equal number of parents and informal care givers. Therefore, allowing conclusions about phenomena across a wide population to be drawn. However, Lidgate et al. (2018) recruited a relatively small sample size of 14 participant and therefore results may not be generalisable but transferable.
Burton et al. (2019) and Lidgate et al. (2018) studies recognises the increase risk of obesity in children and young people. The development of health behaviours is impacted by parental attitudes and activities, media exposure and the home environment, in Robinson et al. (2017) study the relationship between screen media exposure and obesity was widely explored, the findings of the study revealed that children/young people consume a relatively large proportion of their daily calories and meals while engaging with screen media. Poitras et al. (2017) identifies the significance of the behavioural problems that may arise when being exposed to screen time in his study, he expressed a strong link with epidemiologic studies reveal that children who consume more screen media also consume fewer fruits and vegetables and more energy-dense snacks, energy-dense drinks and fast food, receive a higher percentage of their energy from fats, and have a higher total energy intake. Jusienė et al. (2019) conducted a cross-sectional data design study and found that, that screen use during meals in early childhood is related to overall screen time and the use of TV as a background, and also associated with more frequent consumption of junk foods. Potential strategies were identified in (Paudel et al,. 2017) systematic review to reduce television time include messages to parents about not having a television in children’s bedrooms, encouraging family rules restricting television viewing, and not having the television on during dinner. However, Sisson et al. (2016) concluded the lack of conclusive evidence to the effect of screen media exposure as parents could not report how much time the teenagers spent on their mobile phones or video games as they spent majority of their time in their bedrooms. Therefore, the interventions that were suggested in Burton et al. (2019) and Lidgate et al. (2018) studies are based on the must up to date evidence, incorporating intervention to manage obesity, including parents in collaborative decision making on the preference of dietary requirement. In accordance with the NMC (2018) it is essential to keep up-to-date and practice effectively in line with the best available evidence for the safety of the patient receiving care, Nurses may provide parents and children with nutritional advice and provide strategies to minimise caloric intake and increase physical activity through weight management services. The actions of nurses should always take a family approach because, if not supported by their families, it is challenging for obese children to change their dietary or physical habits. Nurses must work towards overcoming childhood obesity with all members of the multidisciplinary team as it is a major health issue with long-term morbidities National Institute for Health and Care Excellence (NICE) ,2015). To recognise this in relation to childhood obesity, it is important to educate children and their families about thorough physical activity. Their involvement is essential in enabling them to select changes in lifestyle that they can accommodate and sustain.
The development of obesity in childhood is clearly affected by a number of factors. Consequently, strategies to childhood obesity prevention and treatment must include the many potential heritable or predisposing factors. Therefore, they will aim to increase the probability of intervention compliance. Laws et al. (2014) concluded that children that were obese and did not receive any intervention had no changes in their weight and those who had appointments with a single session did not experience weight loss. Weight loss over two years, however, was noticeable among patients undergoing intensive long-term care. It consisted of physical exercise, nutritional education, and behavioural therapy, with periodic two-year assessments. Burton et al. (2019) study concluded that only management of the issues thought to be involved in the development of obesity, including diet and dietary education, exercise, decreasing sedentary activity, and family-based interventions. To overcome this, it is important to assess all children and young people in order to predict who is at risk of obesity so effective intervention can commence. According to Bourgeois et al.
(2016) the efficacy of sustained intervention was revealed in their study, this embraces nutrition, exercise, education and food-related behaviour, are necessary to enable children who are overweight to achieve sustained weight loss. Public Health, (2017) states that ongoing support is necessary during health promotion, as it empowers the patient and family to . Burton et al. (2019) and Lidgate et al. (2018)) both agreed that the parents play an important role when it comes to obesity intervention/treatment, similarly, Redsell et al. (2016) literature reviewed different studies and found limited quality data on the effectiveness of obesity intervention programmes and a lack of generalisable conclusions regarding dietary education and exercise. Nonetheless, Cohen et al. (2013) state that, while there is no absolutely conclusive evidence regarding the best interventions at present, these should include comprehensive management of the issues thought to be involved in the development of obesity, including diet and dietary education, exercise, decreasing sedentary activity, and family-based interventions
Oen, & Stormark, (2013) both suggested that the best approach is general advice on healthy eating and education that helps children and families to consider healthy eating values rather than specific instructions. The overall message from a dietary perspective seems to be that what could be widely considered a’ healthy diet’ will be beneficial in most cases of childhood obesity. World Health Organization, (2016) considers that this will be adequate in most situations and that children in the ‘ obese ‘ group must be referred to a paediatric dietician or multidisciplinary specialist team rather than general dietary advice. Lidgate et agrees that preventing and addressing childhood obesity as a significant problem is the responsibility of health care professionals, not necessarily one they feel comfortable with. Elinder et al. (2018) recognises the need for further training opportunities for health care professionals related to childhood obesity prevention and treatment. It requires not only nutritional knowledge, but also understanding of the obstacles to diet and activity-level improvements. Homer et al. (2016) study indicates that dieticians, who are potentially better positioned to educate children and their families on obesity-related issues, were less likely to identify obstacles to effective treatment (such as lack of parental participation, lack of enthusiasm, and lack of provision ) from paediatricians or paediatric nurses. However, Burton et al. (2019) and Lidgate et al. (2018) inclusion criteria potentially excluded the benefit health professionals’ impact on child obesity from their studies. Wynn et al. (2018) carried out a study to see the effect of health practitioners’ attitude towards patient that were obese, in this study health care staff felt uncomfortable in applying coping strategies, offering parental advice and resolving family conflict than in other aspects of obesity management. Gori et al (2017) highlights that Since the complex interactions between family, education, wider society, food consumption, leisure activities, family relationships, beliefs and values are all interlinked factors that affect obesity management, the training of health care professionals must include how these care elements can be approached. Zhu et al. (2015) agrees with this statement as it indicates that health care practitioners ‘ knowledge must go beyond factual information related to the causes of illness, genetic defect, and food intake and energy production. This corroborates with the evidence relating to childhood obesity in Nault, (2015) study as it appears that facilitated group discussion may be useful in such trainings in order to allow health care professionals to become more comfortable in participating in challenging conversations that appear to be necessary for the management of childhood obesity.
NICE guidance validates the importance of school years as a key time for shaping attitudes and behaviours; the importance of opportunities for children to be active and develop healthy eating habits; and the need to involve parents and carers (NICE) ,2015). NICE released recommendations that proposed that all health care professionals give guidance to patients with overweight based on individual desires and needs. Nurses have been recommended to address weight, diet and exercise at periods when weight gain is more likely, such as during and after pregnancy and around menopause time (Department of Health, 2012). The guidelines continued with the health care professional’s recommendation to determine when to assess weight and height and to tell the child, parent or young person how their weight affects their risk of long-term health issues.
From the extensive reading I have undertaken I will take a family-centred approach because it is challenging for obese children to alter their dietary or physical habits if not supported by their families. Royal College of Nursing, (2012) states health care professionals therefore need to be able to work with entire families and address the complex issues of personal lives, beliefs and values, and how individuals can develop a healthier lifestyle. This will certainly require further training in order to build confidence in this crucial part of care (Public Health, 2013). I will explain sensitively why obesity has specific health impacts, such as diabetes and heart disease. in situation whereby families are not willing to make changes, in my future practise I would make a dietician review as they may be willing to discuss future lifestyle changes. I will document family meeting and keep a copy of the objectives agreed so that they can any professional involved in their care can communicate sensitively with families.
As a third-year student nurse, I recognise that I may be limited in ways to communicate with families about obesity, in my future practice I will spend a day with a dietician to undertake further training in order to specialise in this topic area. I believe this would enhance my future practice because I would be able to advocate and raise awareness for the potential health risk if weight management scheme is not applied. I will work alongside other nurses and explore, the most up-to-date evidence-based approach to help foster a healthy learning environment (Doody, & Noonan, (2016). In addition, I will continue to focus critically on evidence of effective ways to promote health and address sensitive issues such as obesity, ensuring that my knowledge, expertise and training remain up to date. In nursing, reflection is important as it allows us to correct practise by identifying the risks and difficulties that may emerge (Standing, 2017). This is important to the revalidation of the NMC and the ongoing development of my skills. This critical reflection will help me in my future practice.
To conclude, the essay highlights the fundamental intervention to minimise the risk of obesity. nurses need must continue to develop their skills and following up to date research, as they have a tremendous impact on patient care. Refection in practice is crucial as it helps to consider and improve care and reflection in practice is essential as it facilitates better outcomes (Finch, 2016).