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Introduction
The issue of obesity is now trending globally. The absence of physical activity among individuals struggling with overweight is also prevalent. Moreover, these two problems combined have a great impact on children and may increase premature mortality rates in middle age (Muthuri, Onywera, Tremblay, Broyles, & Fogelholm, 2015). The problems of overweight and lack of physical activity are exposed to numerous implications for morbidity. Nonetheless, parents are also connected to the issues of childhood obesity and insufficient exercise (Muthuri et al., 2015). Therefore, the significance of the paper can be explained by a number of factors. The researcher is interested in studying the relationships between overweight and parental education, child overweight and physical activity, and investigate the domestic co-occurrence of overweight on a country-wide scale (Muthuri et al., 2015).
Background and Significance of the Problem
The background of the issue is contingent on several perinatal aspects that include maternal obesity in the period before pregnancy, smoking during pregnancy, and rapid weight gain identified in infants (Birbilis, Moschonis, Mougios, & Manios, 2012). Other parental features that have an impact on the childs BMI are the fathers technical education and being overweight. The results of the study conducted by Birbilis et al. (2012) showed that there is a positive correlation between maternal BMI and childs BMI (P=0.05) and a negative correlation between the parents education and childs BMI.
The BMI for children and teens is calculated the same way it is for adults, but the results of the calculations are interpreted in a different way (About BMI, 2015). The calculations should be sex-specific due to the different amounts of body fat within several age groups. The amount of body fat also varies between boys/ girls, and these differences can be shown visually by means of a BMI chart displaying the percentile ranking (About BMI, 2015). These rankings are rather important and represent an all-inclusive array of data concerning the 2 to 19-year-old individuals that were collected during the 1960s and late 1980s in the United States of America (Childhood Obesity Trends, 2016). The significance of the problem reviewed in the proposed study consists in the fact that more than 40% of the children (regardless of their sex) are exposed to obesity issues as their BMI is at the level of the 95th percentile or even higher.
Statement of the Problem and Purpose of the Study
The problem of the proposed study is that the number of slightly overweight and obese infants is growing (Daniels, Mallan, Nicholson, Battistutta, & Magarey, 2013). Consequently, we should carefully identify, assess, and evaluate the factors that may become obesity triggers in the future. It is safe to say that the problem of obesity is relevant and should be approached promptly to identify the key premises and eliminate them or to minimize their influence on the children and the prevalence of adverse outcomes in adulthood (the risk of traumatological issues increases by 4.5% and the correlation between high BMI and cancer tumors increases by approximately 5%) (Muthuri et al., 2015).
The researcher is keen on defining the gravity of the impact of each of the identified triggers and proposing methodologies intended to mitigate the adverse effect of parental characteristics. As stated by Daniels et al. (2013), the healthy lifestyle of the parents majorly affects the didactic outcomes in their children (for instance, increases their average grades at school by 0.1-0.4 points) (Daniels et al., 2013). An extensive literature review was conducted to study the nutritional and behavioral patterns inherent in the children and examine the parental factors that affect the perception of overweight (such as fathers practical education and mothers smoking and nutritional patterns which were proved to increase the risk of premature mortality by 1.2%) (Birbilis et al., 2012). The purpose of this study is to identify the correlations between the childrens BMI and their parents level of education with the intention of outlining the natural outcomes of these correlations.
Literature Review
There is no doubt that the present situation with childhood obesity is a serious problem in our society. Due to that, there is an urgent need to study the discussed topic more thoroughly to be able to answer the most important questions and develop the necessary solutions. It is necessary to say that the majority of the researchers who have worked on this problem were able to make conclusions that can extend our knowledge of obesity in children, its reasons, and outcomes. Many findings reported by the previous researchers can be used to strengthen this paper.
To conduct research that would possess practical significance, it is important to use only academic sources. To find credible scholarly literature, I used Google Scholar. All the articles chosen for the review are from peer-reviewed scholarly journals about nursing and medicine. Keywords used in the search for relevant peer-reviewed articles included terms such as childhood obesity, family education, children BMI, and adolescent health. The chosen sources appeared no more than five years ago, and they are devoted to childhood obesity and the factors that cause it.
In their work, Antonogeorgos, Panagiotakos, Grigoropoulou, and Priftis (2013) study the connection between the educational level of adult people and the BMI of their children. As a part of the research, the authors conducted the experiment with more than a thousand participants. Adult participants were to answer a series of questions concerning their eating habits and level of education. Furthermore, the data on childrens body characteristics were collected, and they were divided into groups according to their BMI. In the end, the authors concluded that children whose parents were more educated were likely to be healthier and apply the principles of healthy eating.
The findings of Antonogeorgos and his research group concerning the connection of parents education level and their childrens feeding behavior support the evidence from another study conducted a year earlier. In their article, Birbilis, Moschonis, Mougios, and Manios (2012) try to single out and study the factors that can have a significant influence on the health of adolescents. During their research, the authors used measurements and personal information of more than two thousand students from 9 to 13 years old to study their state of health in connection with such factors as body mass index of their parents (especially mothers), vicious habits that their mothers had at pregnancy, and different factors connected to social background and income level of their families.
The level of education of the parents of overweight children was also taken into consideration. The authors managed to find the connection between childrens risks to become obese and their mothers behavior during pregnancy and after the period of lactation. Furthermore, there were a few risk exposure factors connected to their parents national identity, low level of education, and high body mass index. In the end, the research affirmed the presupposition concerning a multi-faceted nature of obesity in children. Despite the possible limitations of the discussed work, it can be used as a theoretical background of the present research. If compared to the previous article, this one seems to be more substantial as the authors reveal the significance of parents education level about other factors such as nationality and body weight.
Unlike the previously mentioned researchers, other authors interested in the topic made attempts to study it, focusing on the role of mothers. Although it is focused on a narrower group, its results also give support to the ones delivered earlier. Within the frame of their research, Daniels, Mallan, Nicholson, Battistutta, and Magarey (2013) studied the effects of the universal campaign conducted to popularize feeding practices able to prevent obesity in children. About seven hundred women with their first-born children were engaged in the experiment. The participants were randomly divided into two groups; mothers from the first group could make decisions on breastfeeding on their own.
The participants from the second group were given an opportunity to attend a special education program devoted to feeding practices and their importance. The effects of such intervention were assessed half a year after the end of the program. The data was collected with the help of questionnaires; the state of health of the children was also assessed. In the end, the authors found out that mothers awareness of feeding practices significantly increased, and they were using most of the knowledge gained during the experiment. Nevertheless, no connection between participation in the program and lower childhood obesity rates was found. Despite this fact, the participants increased level of awareness was expected to have a positive influence on childrens health in the future. Unlike previous studies in the field, it highlights the importance of mothers education for their childrens health.
The conclusion about a negative correlation between a high level of parents education and increased BMI of their children was confirmed by one more study. Matthiessen, Stockmarr, Fagt, Knudsen, and BiltoftJensen (2014) studied the cases of many Danish children to define if there was a connection between their body mass index and their parents level of education. The authors analyzed the health data of more than five hundred children and the health data of their parents. Interestingly, the results were different for mothers and fathers of the participants. The educational level of mothers was higher than that of fathers, and it had a stronger connection to their childrens health condition. In the end, the authors concluded that there was a need to launch more health initiatives pointed at informing uneducated people. Unlike other researchers in the field, the authors managed to assess mothers and fathers influence separately.
One more study on the topic was conducted two years ago. It is aligned with previous results; nevertheless, its authors do not focus on only one country. The article by Muthuri, Onywera, Tremblay, Broyles, and Fogelholm (2015) is devoted to childhood obesity in different countries and the factors contributing to its growth. Within the frame of the research, the authors studied the connection between obesity in children (and their level of physical activity) and a few factors connected to their parents, such as education level and health situation. More than four thousand children from twelve countries became the participants of the experiment. During the research, the authors collected the data on their body mass index, physical activity levels; furthermore, they considered the physical parameters and education levels of the participants parents. In the end, the authors confirmed the results of previous research in the field. They found the connection between obesity in children and their parents.
Furthermore, they concluded that the low education level of the parents and obesity in children were also interconnected. In the context of previous studies, it has shown that the connection between the two discussed factors is not typical for countries. Research conducted by Schalkwijk et al. (2015) found that the incorporation of healthy lifestyle interventions among families with obese children is usually met with resistance and lack of enthusiasm, especially from parents that do not pay enough attention to the healthy diet of their children. This study suggested that peer support could potentially stimulate the process of adopting a healthy family lifestyle: parents should be encouraged by other parents to implement healthy changes while children needed to see how their peers incorporate active practices in their daily lives. The level of parents education plays a crucial role in this context because those parents that did not receive adequate education may require enhanced support from their peers to educate them about the importance of a healthy lifestyle for children and households in general.
Natale et al. (2014) also found that parents play a detrimental part in preventing and eliminating childhood obesity because they usually act as role models when children undergo healthy lifestyle changes. Poor nutrition and the absence of physical activities in households significantly increase the chance of children developing obesity. Furthermore, inadequate education of parents may lead to giving bad examples of lifestyle choices to their children. On the other end of the spectrum, educated but busy parents may not have enough free time to dedicate to the diet of their children, which can also subsequently lead to poor lifestyle and nutrition choices. Moreover, it is important to mention that researchers emphasized the participation of teachers in facilitating childrens healthy lifestyle habits because they act as caretakers at times where parents are not around.
In the conclusion of the literature review, it is important to distinguish a successful implementation of healthy lifestyle intervention. The pilot study conducted by Davison, Jurkowski, Li, Kranz, and Lawson (2013) took an innovative approach towards healthy lifestyle interventions and involved parents in the process of research and development instead of scientists or health care providers. In their study, parents played an active role in planning, developing, and conducting family-oriented obesity interventions to improve the health outcomes of their overweight children. The results of the intervention were quite successful: compared to childrens BMI measured pre-intervention, post-intervention indicators significantly improved. Furthermore, parents reported an increased self-efficacy in promoting a healthier diet to their children as well as supporting enhanced physical activity.
It is necessary to add that there are no significant disagreements on the results between the authors of different articles. The only difference is connected to the peculiarities of nations that they were studying. Apart from that, all the researchers support the idea of the connection between obesity rates and educational level. Furthermore, some of them prove that the mothers influence on childrens health situation is much stronger.
Despite all the sources mentioned above, there is a need for further research in the field, and the present work is aimed at filling this knowledge gap.
Research Questions, Hypothesis, and Variables
In children ages 2 to 12 years suffering from obesity as shown by BMI, what is the correlation between the parents level of education and category of the healthy lifestyle and their childs BMI?
The research hypothesis of the current study is that parental education and a healthy lifestyle are correlated to the level of obesity in their children. The null hypothesis of the study is that parental education and a healthy lifestyle are not correlated to the level of obesity in their children.
The demographic variables that will be measured are parents and child age in year, the gender of children as male or female, type of family structure as one or two parents, culture measured as Asian, African American, Hispanic, White, Mixed or other. Research variables that will be measured are child/s BMI using the formula from CDC ( About BMI, 2015); parents level of education as none, 1- 6 years of elementary, 1 4 years of high school, college as attended or degree as AD, BS, MS, Ph.D., other; score using a standardized tool (such as T-test).
Theoretical Framework
Overview and Guiding Propositions
In this project, I will use Betty Neumans Systems Theory because it provides a holistic approach that can be applied to children and parents. It provides a focus on the multiple factors of the environment that plays a part in determining the weight of a child. Individual risk factors directly influence a childs weight. These factors are influenced by societal and familial characteristics. Some of the significant family characteristics are the nature of composition and structure of the family, parenting styles, parental exposure, healthy lifestyles, and the feeding choices employed at the maternal level. According to the theory, it focuses on the response of the patient system to actual or potential environmental stressors and the use of primary, secondary, and tertiary nursing prevention intervention for retention, attainment, and maintenance of patient system wellness (Flaherty, 2013, p. 56).
Application of Theory to Study Focus
With the implementation of this theory, nurses can implement prevention intervention to modify the childrens lifestyles to get the outcome of a reduction in weight. Applying this to my problem, we would have as intervention the assessment of children to identify risk factors in addition to the educational exposure of the parent with regards to best practices that surround healthy lifestyle is particularly important in influencing how best they pass that knowledge to practice and ensure the prevention and control of obesity through natural means.
In the event that a child suffers from obesity, such knowledge comes in handy to help offer medical means for the mitigation of the problem. At the individual level, the characteristics include habits, genetic factors, motivation, coping strategies, and interests. As an infant, these individual factors can be developed through the continuous interaction with an environment that promotes healthy living (Flaherty, 2013). Finally, the societal characteristics related to obesity among infants include the influences of communities and schools, economic barriers, and the demographics of the neighborhood. Betty Neumans Systems theory correlates a childs weight to various environmental factors. In so doing, it effectively addresses the cumulative impact of society, family, and individual factors that play a part in whether a child ends up with obesity or not.
Methodology
To answer the research question about a childs BMI and parents level of education and lifestyle, a quantitative research paradigm has been chosen. Quantitative research is an objective approach to research using numerical data to measure the variables of the study. This approach allows a researcher to conduct data analysis using inferential statistical tests, so the personal bias is less likely to influence the analysis of data and final research results (Grove, Burns, & Gray, 2013).
Sample/ Setting
The sample population used in the study will comprise parents whose children are between the ages of 2 and 12 years. The setting of the study will include four family practices and four pediatric clinics in the Northern region of the United States. Healthcare facilities were chosen as the primary settings of the study because they can provide a researcher will a relatively large sample size of parents with obese children to involve in the study. Moreover, parents will feel more comfortable discussing the lifestyle and diet choices of their children in a setting that is associated with promoting better health outcomes. Obtaining health information such as childrens BMI records will also be convenient to do in a healthcare facility. For the researcher to make accurate inferences of the study, the most suitable sample size will be 100 or more participants. A sample size calculator will be used to determine if this sample size is adequate to obtain reliable and valid data (SurveyMonkey, 2017). Inclusion criteria will be associated with enrolling parents who have children between ages 2-12, diagnosed with obesity. The exclusion criteria will include maternal obesity while pregnant, smoking during pregnancy, and the fathers weight.
Sampling Strategy
The principal investigator (PI) will access clinic records to determine which parents meet the inclusion criteria. An email will be sent to all eligible parents describing the purpose of the survey research, criteria they need to meet if they volunteer to participate in an online survey. Important information included is the contact information for PI for any questions about the research, an informed consent statement, assurance that there is no cost to participants, and that survey results will be anonymous. Participants will be instructed to access the survey at a secured Internet survey site using a secured password. They will be asked to complete the survey within two weeks of receiving the email invitation. Enrollment will continue for a 90-day period or until the required sample size is achieved. Reminder emails will be sent at the end of weeks 1 and 2 after the first email. There is no material reward for participating in the survey.
Research Design
The type of research design used in a study has a significant influence on the quality and accuracy of the data gathered. The researcher will enroll study participants by giving out pamphlets containing general information about the study. Moreover, it could be an effective strategy to cooperate with health care providers in pediatric and family practice facilities. For example, if a family with an obese child came to visit their podiatrist, the healthcare provider may give them some brief information about the research and offer them an opportunity to participate for the good of their child. It is crucial not to pressure families into participation because their resistance may negatively influence the results of the study. Parents willingness to participate is regarded as a component of the success of the study because they have the greatest influence on the health of their children.
A quantitative correlation design was chosen to answer the research question. This design focuses specifically on relationships among variables and can identify interrelationships between variables in a short period of time; therefore, quantitative correlation design is cost-effective and is more likely to ensure high levels of participation from families with obese children (Grove, Burns, & Gray, 2013). This research design will be able to demonstrate the correlation between parents level of education, lifestyle, and childs BMI. Thus, the research will focus on determining whether a decrease or increase in one variable influences the increase or decrease in another; for example, it may be found that the high level of parents education is correlated with a healthier diet of their children while the low level of education is associated with childhood obesity an unhealthy family lifestyle.
Quantitative correlation design will aid the researcher in identifying three types of possible correlations between variables: positive, negative, and no correlation. A positive correlation between the examined variables implies that an increase (or decrease) in one variable causes an increase (or decrease) in another. A negative correlation is opposite to a positive and implies that a decrease in one variable causes an increase in another and vice versa. Lastly, a negative correlation shows that the variables examined during research are not correlated. Determining the type of correlation between parents level education, the category of their lifestyle, and the BMI of their child will help the researcher to outline appropriate strategies for dealing with childhood obesity and educating parents about the importance of a healthy lifestyle.
References
About BMI. (2015). Web.
Antonogeorgos, G., Panagiotakos, D. B., Grigoropoulou, D., & Priftis, K. N. (2013). The mediating effect of parents educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study. International journal of public health, 58(3), 401-408.
Birbilis, M., Moschonis, G., Mougios, V., & Manios, Y. (2012). Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. European Journal of Clinical Nutrition, 67(1), 115-121.
Childhood Obesity Trends. (2016). Web.
Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Daniels, L. A., Mallan, K. M., Nicholson, J. M., Battistutta, D., & Magarey, A. (2013). Outcomes of an early feeding practices intervention to prevent childhood obesity. Pediatrics, 132(1), 11-19.
Davison, K., Jurkowski, J., Li, K., Kranz, S., & Lawson. (2013). A childhood obesity intervention developed by families for families: Results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10, 3-10.
Flaherty, K. M. (2013). Neuman Systems Model in Nursing Practice. Nursing Theory: Utilization & Application, 200.
Grove, S.K., Burns, N., & Gray, J. R. (2013). The practice of nursing research: Appraisal, synthesis, and generation of evidence (7th ed.). St. Louis, MO: Saunders/Elsevier.
Hubbs-Tait, L., Kimble, A., Hingle, M., Novotny, R., & Fiese, B. (2016). Systematic Review of Child Obesity Prevention and Treatment Trials Addressing Parenting. The FASEB Journal, 30(1 Supplement), 1155-6.
Matthiessen, J., Stockmarr, A., Fagt, S., Knudsen, V. K., & BiltoftJensen, A. (2014). Danish children born to parents with lower levels of education are more likely to become overweight. Acta Paediatrica, 103(10), 1083-1088.
Muthuri, S., Onywera, V., Tremblay, M., Broyles, S., & Fogelholm, M. (2015). Relationships between parental education and overweight with childhood overweight and physical activity in 9-11-year-old children: Results from a 12-country study. PLOS One, 11(8), 3-21.
Natale, R., Messiah, S., Asfour, L., Uhlhorn, S., Delamater, A., & Arheart, K. (2014). Role modeling as an early childhood obesity prevention strategy: Effect of parents and teachers on preschool childrens healthy lifestyle habits. J Dev Behav Pediatr, 35(6), 378-387.
Schalkwijk, A., Bot, S., de Vries, L., Westerman, M., Nijpels, G., & Elders, P. (2015). Perspectives of obese children and their parents on lifestyle behavior change: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity, 12, 102-110.
SurveyMonkey, (2017). Sample size calculator. Web.
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