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At present, obesity is one of the most widespread chronic diseases in the world. Obesity is the disease characterized by the broken metabolism, as well as excess accumulation of fatty tissues in an organism. According to the majority of researchers studying this problem, excess consumption of food and insufficient physical activity are the main causes of obesity. Moreover, heredity also plays a role in the development of childhood obesity. According to Farpour-Lambert et al. (2014), about 30% of the planet population has an excess body weight. The most significant medical consequences of obesity, i.e. the type 2 diabetes and cardiovascular diseases, include high rates of disability and premature mortality in the modern world (Farpour-Lambert et al., 2014, p. 345). High medical and social importance of the diseases caused by obesity determines the relevance of researches in this direction.
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In their qualitative research called “Childhood obesity is a chronic disease demanding specific health care – a position statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO)”, Farpour-Lambert et al. (2014) state that medicalization of obesity determines the disorder as a disease with the number of signs and symptoms (p. 344). The authors of the research state that obesity is met in 15-20% of children of all age periods, especially in puberty. Children living in cities are more vulnerable to the disease than those from villages. A timely and effective collaboration of scientists, researchers, and clinicians can become a powerful instrument in the struggle with childhood obesity.
The research gives a profound overview of the problem of childhood obesity. The findings of the research are consistent as they represent a lot of well-grounded arguments and facts stating that obesity is the disorder, which has all grounds to be treated as a disease. The study is limited to the research of childhood obesity as a disease in the European countries by the European Association for the Study of Obesity (EASO).
The article “Incidence of childhood obesity in the United States” written by Cunningham, Kramer, and Narayan (2014) is the quantitative research of the incidence of obesity among kindergarteners and elementary school children. The authors of the research have found out the tendency, which does not depend on the gender or age. It includes the advancing of peers in the physical development from the puberty with the shift of the growth jump approximately for 1-1.5 years (on average at the age of 11-12 for boys and at the age of 10 for girls).
The special attention has been paid by Cunningham et al. (2014) to the changes of body weight in boys with obesity at a school age characterized by three periods of the biggest gain of weight: 9-10 years, 11-13 years, and 14-15 years (p. 405). Girls with obesity also gain most weight before puberty (7-8 years) and after the arrival of menarche (12-13 years), as well as after 14. On the contrary, girls without obesity, evenly adding in weight in the period of an active puberty (10-12 years), gain weight insignificantly against the background of growth rates delay. Thus, they demonstrate the stable body weight indicators after the age of 14 (Cunningham et al., 2014, p. 409). Moreover, the researchers state that obese kindergarteners at the age of 5 have more risks to become obese teenagers and adults if compared to children with normal weight.
The main goal of the study is to research the incidence prevalence among kindergarteners and schoolchildren in the USA. The research covered 7,738 participants who were kindergarteners in 1998-1999 in the USA (Cunningham et al., 2014, p. 405). The researchers have been monitoring weight and height indicators of children for more than nine years, taking into consideration such factors as their social status, ethnicity and racial accessory, as well as gender. The findings of the research show correlation between obesity in schoolchildren and teenagers and the overeating within the first years of life (Cunningham et al., 2014, p. 410). The limitations of the study include the grouping of such ethnicities as Asians, Native Americans, and Pacific Islanders into the ‘other race’ category. Moreover, the study does not present any information on weight and height of its participants from the birth to kindergarten.
The research of Mohamed (2015) covers general problems of childhood obesity, prevalence rates, determinants, behavioral characteristics, and prevention strategies. The study emphasizes the role of genetics, as well as nutritional patterns of children and their effects on the development of obesity in children. Moreover, having conducted the qualitative research, the author of the article states that such behavioral characteristics as an inactive way of life, shifts in sleeping hours of children, the abuse of television, and computer result in the pediatric obesity (Mohamed, 2015, p. 2). The study is limited to the discussion of the problem of obese children only in Africa and Asia. The findings include intervention strategies, especially in schools, which can contribute to the reduction of obesity rates among children. Such interventions are aimed at increasing physical activity and promoting changes in eating habits among children in families and at schools.
The article written by Boisvert and Harrell (2015) represents the qualitative research based on the integrative approach to childhood obesity. Boisvert and Harrell (2015) state that the problem of obesity both in the world and in the USA in the particular acquires the epidemic scales (p. 40). The researchers cover prevalence rates, etiological, psychological, and spiritual factors, as well as treatment strategies. There is the focus on cognitive, behavioral, and animal-assisted therapies in the paper. The findings state that educational interventions also play an important role in the struggle with childhood obesity. The research is the qualitative study of childhood obesity. The study is limited by the analysis of biological and psychological factors of obesity in children, as well as medical interventions.
The group of researchers, including Kuhle, Doucette, Piccinini-Vallis, and Kirk conducted the research on successful management of childhood obesity in Canada in 2015. The study discusses the problem of obesity as a multi-step behavioral process, all steps of which should obligatory be completed (Kuhle et al., 2015, p. 2). The quantitative research of the pediatric obesity management analyzes steps involved in assessment, diagnosis, and treatment of pediatric obesity by primary care providers (PCP). There are 23 childhood obesity management programs in Canada. The findings of the study state that the rate of obesity management amounts to 0.6% per year (Kuhle et al., 2015, p. 4). Limitations of the study include non-inclusion of the pharmacotherapy and bariatric surgery, as well as absence of a consistent definition of the concept ‘weight maintenance’.
If one is to compare all five analyzed researches, it is possible to state that all of them have a lot of similarities as they discuss the problem of childhood obesity as the threatening tendency all over the world. Moreover, the authors of all articles indicate the same biological, genetic, and psychological factors causing gain of weight in children. Besides, all five studies are not narrowed to one obesity indicator. Instead, they discuss an integrative approach to the problem of childhood obesity, analyzing a number of obesity indicators. Moreover, two out of five studies are quantitative researches, while three belong to the qualitative ones.
As for the differences, all five researchers are different by the level of generalization of the childhood obesity problem. The first research conducted by Farpour-Lambert et al. (2014) gives a general overview of the obesity epidemics. The second research conducted by Cunningham et al. (2014) is focused on the quantitative incidence of obesity among kindergarteners and elementary school children. The study is narrowed to the definite age category of participants and includes a lot of statistical data. The third article written by Mohamed (2015) covers genetic pre-requisites of childhood obesity, as well as the behavioral impact on the gain of weight. The study is narrowed to the analysis of obesity in Africa and Asia. The following research conducted by Boisvert and Harrell (2015) is focused on behavioral and animal-assisted therapies, as well as educational interventions. The fifth, article represents weight management strategies successfully applied by the Canadian state programs. All researches vary by their focus and object of research.
Diseases connected with obesity annually cause millions of deaths all over the world. It is important to note that about a half of all children and teenagers having excess body weight remain obese during adulthood. The lack of uniform approaches to the diagnosis of obesity in children and teenagers complicates the obesity incidence monitoring. In the USA, the problem of obesity in children has reached the epidemic sizes. It has induced the governmental bodies to create the working group, which has developed guidelines and recommendations about diagnostics, treatment, and prevention of obesity in children and teenagers for the practical health care.
The guidelines and recommendations about diagnostics, treatment, and prevention of the pediatric obesity have been developed by leading experts in the field of the pediatric endocrinology, cardiology, preventive medicine, and dietology. They are based on the analysis of the world and American publications, normative documents, health care protocols, and the WHO recommendations. The guidelines on combating obesity include the determination of excess body weight and obesity, classification of obesity, as well as the methods of diagnostics. Moreover, they specify negative consequences of obesity for the health of children and adults. Risk factors of obesity and main prevention strategies during different age periods are also described in the guidelines. Besides, they emphasize advantages of breastfeeding, rationalization of food, and optimization of physical activity, as well as contain methods of medical treatment of obesity and the standard strategy of body weight control. The recommendations are intended for physicians of various specialties such as the pediatric endocrinologists, pediatricians, cardiologists, and pediatric nursing practitioners (PNPs).
There are a lot of guidelines aimed at supporting health of children and adults. The Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (2008) focuses on the improvement of children’s health by means of disease prevention strategies and clinical health promotion. The guidelines differ from the majority of other similar recommendations by the provision of up-to-date directions of the “what to do” and “how to do it” correctly (Hagan, Shaw, & Duncan, 2008, p. 203). The guidelines offer four main components in health care support, namely detection of the disease, promotion of health, and the anticipatory guidance. Moreover, they include the main points of a healthy lifestyle, i.e. what must be done, what needs to be done, and what is desirable to be done.
Special attention is paid to the problem of excess weight and obesity in The Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. It is recommended to consider the obesity risk in such cases if “one or both parents are obese; one or more siblings are obese; they are from families with low incomes; they have a chronic disease or disability that limits mobility” (Hagan et al., 2008, p. 111). Thus, the guidelines are intended for pediatricians, therapists, and PNPs.
The book Pediatric Primary Care written by Burns et al. (2016) represents guidelines for Pediatric Nurse Practitioners (PNPs) and Family Nurse Practitioners (FNP) as the primary audience. The recommendations are focused on the prevention of health care problems. Each chapter is compiled in such a way as to allow the NPs to understand the key concepts of the primary health care, discussion, management of diseases, and prevention strategies. The guidelines are organized in the form of the four-part structure, including the bases of the pediatric health, assessment of child health, the perspectives of the pediatric health care from the perspective of culture, child development management, and disease prevention (Burns et al., 2016, p. vii). The Unit 3 of the guidelines is devoted to approaches to the health management in the pediatric primary care. It includes the Nutrition and Physical Activity and Sports for Children and Adolescents sections. They direct the PNPs and FNPs to promote healthy nutrition and an active way of life among children.
The third edition of the Pediatric Primary Care Case: Practice Guidelines for Nurses by Richardson (2016) presents advance practice recommendations for nursing students and the NPs in the pediatric care. Each section contains case studies for common diseases, helping nursing practitioners to diagnose the disease and find the best option of disease management or prevention. Chapter 33 called “Pediatric Obesity” discusses the problems of overweight among children and obesity consequences, as well as guides how to manage the disorder in the most effective way (Richardson, 2016, p. 579).
The book Pediatric Physical Examination & Health Assessment by Sawyer (2012) represents guidelines for the medical examination of children from the birth up to adulthood with a view to assessing their health. The recommendations are rather useful for nursing practitioners as they describe a lot of techniques aimed at the examination of infants and children. The book by Sawyer (2012) teaches the nursing personnel to be accurate and attentive during medical examinations:
Approaching a child with comfort and ease is essential to developing a relationship that affords you an opportunity to perform a skilled examination. Patient compliance, whether a patient is a toddler or an adolescent, is a critical component of a patient-provider relationship. (p. xvi)
Moreover, each chapter is followed by the case study, which allows clinicians to develop diagnostic reasoning, clinical practice, and critical thinking. Thus, the guidelines are aimed at the maintenance of the health of children and adults supervised by nursing practitioners.
Obesity is one of the most widespread diseases in the world. It is found in each age group. The rates of the pediatric obesity have been increasing since the beginning of the 21st century. The progress of this disease in all world countries, especially in the ones with the developed economy, is noticed both among children and adults. The increase in the prevalence of related diseases is associated with the increase in the incidence of obesity: type 2 diabetes, arterial hypertension, atherosclerosis, coronary heart disease (CHD), oncological diseases, etc. The growth of the prevalence rates of obesity in children, which has doubled in developed countries over the previous 20 years, and the high frequency of the disorders of the carbohydrate and lipid metabolism against the background of obesity confirm the relevance of researches on the study of the obesity problem in this age group.
Obesity is both a medical and social problem. Against the background of the obesity epidemic, opportunistic diseases observed only in adults earlier are diagnosed and often demand an immediate treatment at the early children’s age. Almost 60% of the cases of adult obesity are caused by childhood obesity and lead to the development of complications composing the “metabolic syndrome”. Obesity in the adult age that started during childhood has a more severe course and is followed by an expressed increase in body weight and a high frequency of the associated diseases unlike obesity developed at the mature age.
Despite the simplicity of the diagnosis of obesity, success in prevention and treatment of this disease cannot be considered as satisfactory. Low efficiency of different therapies is caused by the fact that obesity is a chronic recurrent multiple-factor disease, requiring a lifelong treatment. Considering the progressing growth of the pediatric obesity rates, the Pediatric Nurse Practitioner (PNP) try to develop optimum schemes of prevention, treatment, and care for corpulent patients all over the world.
The NPs contribute greatly to diagnosis, prevention, and management of childhood obesity. The diagnosis of obesity starts from the clarification of the causes of its development. Definition of possible causes of obesity requires a full medical check-up of a child. The primary medical check-up consists of the anamnesis history, including family and social status, food addictions, physical activity, stresses, etc. At the same time, factors and circumstances, which could promote development of obesity, become clear. The role of the NPs at this stage is rather important as further correctly chosen therapy depends on the correct diagnosis.
The primary prevention of the pediatric obesity by the PNPs is directed at the prevention of the disease with respect to existing prerequisites of its emergence. It includes an adequate increase in the physical activity, stimulating the processes of the metabolic transformation of the food glucose. The secondary prevention of the pediatric obesity also requires active attention and participation of the PNPs. The obligatory prevention actions of childhood obesity include:
· A regular assessment of body weight and definition of body mass index;
· Assessment of a food character and eating habits, both in families and at schools;
· Assessment of the way of life and physical activity of a child;
· Normalization of the sleeping regime;
· Informing a child on danger and harm of overeating and the risk of developing accompanying diseases.
Management of childhood obesity includes such goals as the change of eating habits of obese children, increase of physical activity, and medication. The PNPs should help obese children to substitute the only meal a day with 5-6 small meals, which excludes the feeling of hunger and prevents consumption of junk food. Moreover, they should cultivate the love of sports and physical exercises, which will allow being always fit and healthy. The medication should be used only as the additional means in the struggle with childhood obesity as all medical preparations do not have a prolonged effect. Thus, it is vitally important to follow the guidelines aimed at the pediatric obesity management. They direct the PNPs and help to choose correct methods for the obesity management.
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Annually, the world economy loses $2 trillion while looking for the solution of the pediatric obesity problem. These funds are meant to be spent on treatment of diseases caused by or connected with excessive weight, as well as on the payment of sick-leaves. According to Richardson (2016), these expenses are equivalent to 2.8 % of the world output. The tenth part of all public medical expenditures of the USA is caused by the obesity of the Americans. Every year, the US Ministry of Health spends around $150 billion on treatment of diseases provoked by obesity (Richardson, 2016, p. 25). These funds are allocated among social programs aimed at the prevention of obesity. Education of families on the healthy way of life can have positive results for and a long-term effect on future generations. Correction of eating habits and nutritional balances in families will contribute to the reduction of obesity rates in children. Schoolchildren should get used to sport and healthy and balanced nutrition. People should care for their health since childhood and control their weight, while the PNPs can support and direct them. Thus, having studied the literature on the problem of pediatric obesity and analyzed the guidelines for nursing practitioners, it is possible to draw the conclusion that the knowledge of an etiology of obesity, clinical picture and features of diagnosis of this disease, check-up techniques, principles of treatment and prevention, as well as complications and manipulations will help the NPs to perform well at all stages of the nursing process and achieve a decreasing tendency in the pediatric obesity rate.