NURS3044: How effective is Diet Modification for Prevention of Obesity in Adolescents

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Question: How effective is Diet Modification for Prevention of Obesity in Adolescents

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Obesity is key health concern of today’s world. It increases the risk of long term problems. According to Jeffery M Fredman obesity means excessive body fat. According to AIHW ( ) the trend of obesity is not only restricted to adults, from last two decades the trend is increasing among children and adolescents. Moreover, ABS shows the prevalence of overweight and obesity is increasing in Australia. Data shows the percentage of obesity and overweight is 56.3% in 1995, 62.8% in 2011-12 and 70.8% (men) and 56.3% women in 2014-15. NHMRC estimated that by following current rate of obesity two thirds of Australians will be obese in 2025. Obesity imposes huge economical burden on health care system of Australia. It is estimated that approximately a quarter of adolescents in countries such as Australia and the USA are overweight or obese (National Health & Medical Research Council, 2013a; Ogden et al., 2010), possibly as a result of a societal shift in lifestyle habits, including a reduction in physical activity levels, an increase in sedentary behaviour and increased consumption of energy-dense,

State your chosen or developed research question including the Population, Intervention, Comparison (if relevant) and Outcomes (PICO) OR Population, Intervention/Issue, Outcomes (PIO)
Provide an explanation using appropriate references as to why this research question is important to Nursing/Midwifery practice

Discuss how the process of writing a research question [if applicable] and identifying related research has broadened your understanding of the importance of evidence based practice for nursing or midwifery.

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Solution:Effectiveness of physical activity in obese adolescent

Background information Obesity is a public health problem and a global epidemic of the 21st century with the widespread and alarming growth resulting to both long-term and short-term health implications. According to Annesi et al. (2014, p. 531), childhood body mass index has a direct association with adolescent and adult adiposity and the magnitude of the association majorly depends on the fitness of the individual. On the other hand, adolescent obesity is a strong prediction of the obesity in the early childhood as the results of the study indicate that most obese adolescent had a heavy weight as children. As a result of the alarming increase of obesity among children and adolescent in Australia and globally, many researchers and health intervention programs have been adopted as efforts in various public health campaigns of preventing obesity in school age children and the adolescent. However, there is yet no clarity as to the best approach that can work effectively. According to Hain (2015, p. 563), various studies on different effective intervention programs and strategies have reported little effort of reducing overweight and obesity. However, studies as well suggest that effective intervention methods should focus on the maintenance of the BMI where physical activity can be very essential. The increasing rate of obesity is a global health concern as it has been found to be a major contributing factor to many other serious health disorders such as cardiovascular diseases, hypertension, type2 diabetes, and heart failure among other health infections Ce’line et al. (2010, p. 285). In Europe, Asia, and Australia, the prevalence of obesity has increased by 30-50 % in the last three years. The study reports that the current data from the WHO reports that 10-20% of women, 10-15% of men, 10-15% of children, and 15-25% of adolescent are obese. The increase in the last three years is also supported by data from the Lifestyle, Nutrition, and Attitudes in Australia indicating that the level of self-reported obesity between 2013 and 2016 has increased from 32% to 36%. However, based on the measured data, it is evident that obesity is a global health concern in children, teenagers, as well as the adults (Kalb et al. 2015, p. 217). In their study, Lindval et al. (2015, p. 6) Reports that the high number of obesity cases among adolescent is as a result of the adoption of sedentary activities such as watching TV, concentrating on video-games, cards, etc. In addition, excessive involvement with intellectual activities such as reading, school assignments, qualification courses, and work also contributes to physical inactivity among the adolescent. Time for physical exercise is thus reduced while the mentioned activities above are reported to be coupled with drug abuse and poor eating habits. The study is this important as it will shed light or give a clearer understanding of the effectiveness of various methods that can be adopted by the adolescent in managing obesity. The study will review the effectiveness of the strategy among the adolescent as a result of the current lifestyle adopted that is coupled with technological video games, computer and phone concentration, and movies among other activities. Such activities significantly reduce the time available for physical activity among the adolescent. Physical inactivity causes low fitness in the affected population and thus raises health burdens worldwide. According to Wilson et al. (2012, p. 1225), obesity is one of the leading established mortality and disease burden risk factors. In their study, Shaheen et al. (2010, p. 215), report physical activity and fitness as a major counterbalance of adiposity-related mortality and can thus prolong the life of people with obesity. The fact that physical activities also track into adolescent, thus emphasizes the necessity of evaluating and finding out the effectiveness of increasing the physical activity in the adolescent suffering from obesity. The research will thus be necessary in understanding the most effective methods of physical activities that can be effective when adopted with the adolescent so as to manage excess body weight. For instance, the study is vital as a guide to inform school administrations on the importance of physical activity in schools as a regular program that can be vital to make the teenagers and the adolescent more effective. The research will as well clearly impact on the skills and knowledge that is relevant in the process of nursing intervention practices as physical activities not only manages obesity, but it also contributes to effective health response to chronic illnesses like heart disease, cardiovascular conditions, among others. List of the articles

Henley, W & Wilkin, T, 2010, A 5-month weight-reduction programme has a positive effect on body composition, aerobic fitness, and habitual physical activity of severely obese girls: A pilot evaluation study, Journal of Sports Sciences, 28:3, 281-289, DOI 10.1080/02640410903460734, viewed 27 September 2010.
Callachand, N 2016, 'Obesity: Physical activity and diet',Chemist & Druggist, 284, 6960, pp. 14-16, Business Source Premier, EBSCOhost, viewed 22 June 2016.
Cohen, A, Baker, J, & Ardern, C 2016, 'Association Between Body Mass Index, Physical Activity, and Health-Related Quality of Life in Canadian Adults',Journal Of Aging & Physical Activity, 24, 1, pp. 32-38, SPORTDiscus with Full Text, EBSCOhost, viewed 22 June 2016
Ning, Y, Yang, S, Evans, R, Stern, M, Sun, S, Francis, G, & Wickham, E 2014, 'Changes in body anthropometry and composition in obese adolescents in a lifestyle intervention program',European Journal Of Nutrition, 53, 4, pp. 1093-1102, SPORTDiscus with Full Text, EBSCOhost, viewed 22 June 2016
Salaun, L, Reynes, E, & Berthouze-Aranda, S 2014, 'Adapted Physical Activity, Programme and Self-Perception in Obese Adolescents with Intellectual Disability: Between Morphological Awareness and Positive Illusory Bias',Journal Of Applied Research In Intellectual Disabilities, 27, 2, pp. 112-124, Academic Search Premier, EBSCOhost, viewed 22 June 2016

Article	Reference	Study design	Population	Intervention	Comparison	Outcomes	Comment
1	Céline, A, Olivier G, Yoann G , Alain B , Pierre D & Guy F 2010	5-months multidisciplinary program	18 obese adolescent girls	Standard mean differences for physical activity in relation to the body weight of individuals	Combined dietary-nutritional and education, exercise intervention	Physical activity alone has minimal effect on the weight of an individual
2	Shaheen, M, Schubert, F, Brendan, L, Xue, Z, Yin-Leng, T, Yun-Ke, C, Intan, A & Mokhtar, P 2010,	Survey questionnaires	23- obese adolescent between 14 to 21 years	The effectiveness physical activity and aerobic fitness effective method in the management of obesity	Physical inactivity, nutrition, and behaviour in relation to body weight. The effectiveness of group-based weight-control treatment on adolescent social functioning	Both aerobic fitness and habitual Physical activity was improved in obese adolescent Girls
3	Wilson, J, Mary, E, Anita, C, Jacqueline S, Harry, P, & Cheril, C, 2012	Baseline assessment and post interventions	43 obese youths	Effects of an exercise plus group-based self-regulatory skills intervention On obese youths	Physical activity, body composition, social cognitions, and strength.	Body composition, Social cognition, and strength were Positively impacted suggesting that the intervention is feasible for treating obese adolescents
4	Ackel, D, Carnier, J , Bueno J, Campos, R, Sanches, P, L, Clemente, A, Tufi k, G, Mello, M, Dâmaso, A, 2013	Quantitative evaluation	72 volunteers on 6-month interdisciplinary therapy	Effects of aerobic training, leisure physical Activity, and aerobic Plus resistance training	Insulin resistance, body composition, and leptin concentrations In obese adolescents,	Both aerobic training and its combination with resistance training promoted leptin level reduction
5	Nemet, D, Berger-Shemesh, E, Wolach, B, Eliakim, A, 2006	Random group-based cognitive behavioural aerobic exercise or peer-enhanced Adventure therapy	89 adolescent	Effectiveness of group-based weight-control and treatment on the social functioning of adolescent	Completed social functioning measures at baseline, end of 12-month treatment	Adolescent perceptions significantly reduced on peer rejection and social anxiety with time

According to Ce’line et al. (2010, p. 286) changing dietary habits and physical activity are a key to understand the effective management of obesity and are thus important components in the prevention and treatment strategies of obesity. The study adopted a literature review and analysis of data reported from clinical trials, prospective studies, meta-analysis, and cross-sectional peer reviewed journals, and international report papers. The results showed that combined diet as well as regular physical activity appeared to be the most effective therapy for weight loss or weight maintenance. On the other hand, Shaheen et al. (2010, p. 215), physical activity is thought to be effective in the obesity management yet observational studies show it can only be effective when incorporated with other intervention programs like a healthy diet. It is also associated with many health benefits despite the fact that it is not the most effective way of obesity control and management among teenagers. According to the study, the intervention has been globally unsuccessful in improving the body mass index among the adolescent despite how effective an individual follows the program. However, the study reports that more activity leads to consumption of higher calories and thus offsets any gain in the energy expenditure. It further reports that physical activity as an obesity intervention method does not effectively increase the activity of children in a sufficient manner that can affect adiposity. In the same manner, Namet et al. (2006, p. 667), an adolescent is a period of significant development and physical growth and tend to less evaluated quantitatively by many studies. Their study thus investigates the response in the body weight and BMI in relation to the physical effectiveness of the group. The study finds out that even though the adolescent of the 21st century are lovers of sedentary life, physical activity contributes a higher percentage of the of the weight loss as compared to behavioural adaptations and proper nutrition. However, Wilson et al (2012, p. 1225) report that the synergistic relationship is that dietary restriction results in the reduction of energy expenditure as physical activity results in the increase in energy expenditure. The two strategies combined, thus helps in effective management and or reduction in the body mass without a subsequent reduction in the energy expenditure required for resting. In their study, Ackrel et al. (2013, p. 169) note that the management of obesity is a crucial and complex issue among the adolescent as a result of their perception and morphological variables. The study confirms that obesity and weight management programs for the adolescent require a positive illusionary bias on their self-perception majorly on the sedentary lifestyle they adapted in the 21st century. It thus majorly affects adolescent with disability or under the influence of alcohol and drug abuse that is predicted to accompany the sedentary lifestyle of the current generation. The study concludes that physical activity should be coupled with behavioural change and decisions to maintain the program while avoiding poor diet. According to the study, physical activity alone may not be as effective as it involves intake of high calories due to need for more energy and muscle exhaustion. The above journals tend to have a common point that there is a direct relationship between body weight, BMI, and how active an individual life. Physical activity contributes to burning off the excess fat in the body and hence should be practiced regularly to help in reducing excess fat in the body of an individual. With the sedentary lifestyle of most adolescent of the current generation, the management of obesity requires a joint initiative of the parents, teachers, and the community as a whole to enable health practitioners effectively manage such body weight related health disorders among the young generation. Discussion of the importance of the evidence-based practice and the research study The process of writing the research question and the identification of the related literature on physical activity and obesity in adolescent has positively contributed in broadening my understanding of the nursing evidence based practices. The evidence based practice has brought into my focus different aspects of quality intervention services, consistent with the current knowledge that is research evidence, as well as targeted health outcome. It is thus effective in the alignment of midwifery and nursing services with the current professional knowledge as a key goal of quality service in the nursing industry. It has clearly expressed the underlying belief that research on obesity in adolescent produces relevant and reliable knowledge that proper management strategy will change the condition of the body weight of an individual in the adult stage. The use of the research question as an evidence based method of study involved the characterization of obesity as a global health problem. It is researched question thus involved a review of different literature in different aspects of managing the disease among the adolescent. It has thus enabled me to discover the available gaps for research on different intervention programs that are adopted in the current nursing industry and that need further research for more understanding on their effectiveness (Kalb et al. 2015, p. 213). For instance, it is not yet clear on whether physical activity should be combined with other intervention strategies like proper diet for effective management of the body weight of an individual. Little is also known why most of the adolescent of the 21st century tend to adopt the sedentary lifestyle other than taking part in the physical activities than can keep their feet. According to Kalb et al. (2015, p. 215), evidence based practices involve the integration of best research evidences with patient values and clinical expertise. As a result, the practice unifies the research evidence with relevant clinical expertise, thus encouraging individualization of care through the inclusion of various patient preferences. In carrying out research to different nursing related questions, EBP helps in the knowledge emphasis produced through systematic and rigorous inquiry. Hain (2015, p. 565) in his study supports that the system expands on the experience of the clinicians and patient values, thus providing an encompassing and enduring healthcare and nursing success. For instance, the process has unified the process of intervention programs adopted in the management of obesity together with the different sedentary lifestyles adopted by different adolescent that at times make the management strategy of obesity very unsuccessful. Nursing research tremendously influences the current and future nursing and healthcare practices and is thus rendered an essential component of midwifery or nursing educational process. Sharing the learning experience as well as research from different related studies hence gives learners the opportunity to analyse and understand the strategies presented in various facets of the nursing field. The research process is this vital in a midwifery profession and is necessary for continuing advancements that can promote effective nursing care. As an individual within the profession, I am able to effectively contribute in various skills and experience in chronic illnesses like obesity and its management in relation to other studies. The opportunity for carrying out a study on a research question was thus extremely important and beneficial. Prior to the evidence based study, I was not very familiar with the nursing research as I had a concept that nursing research is only carried out by people with biology biochemistry, medical knowledge and other related degrees. I have now realized that nursing or midwifery can be combined since optional nursing care relies on the latest finding of different research. I have also learnt that nursing in research are as well as nurses in other settings are vulnerable to one another (Warren 2015, p. 30). For instance, developing appropriate intervention programs for the management of obesity among adolescent requires effective participation and a combination of their behaviour, lifestyle, physical activity, as well as assistance by parents and guidance from early childhood. Research and evidence based nursing care are thus necessary as it allows nurses to be better advocates for patients with different health conditions as they can only provide the best care when they have a clear knowledge base and proper understanding of the expected optimal nursing care strategies that is relevant to the disease in question.

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