How to Critically Appraise the Evidence

Title: The association between childcare and risk of childhood overweight and obesity in children aged 5 years and under: a systematic review 

Type of study: a systematic review 

Childcare can be of different ways that may lead but the growth of the children in a certain way. In the case of obesity among children, particular means of bringing up the children are responsible for their overweight conditions. The researchers searched databases such as PubMed, MEDLINE, and EMBASE. The articles were to be between May 2010 and May 2016 and had to be published in English. A total of 15 publications from 7 different countries were found (Alberdi et al., 2016). 

In the articles, informal and center-based childcare were found. It was also found that informal care of the children was mostly linked to their overweight issues (Alberdi et al., 2016). Informal care involved care from relatives, friends, and probably neighbors. The association between childcare and childhood obesity was subtle. All the same, some aspects such as the age at which a given child is initiated in care and informal care were linked to child adiposity. Moreover, short breastfeeding periods were further reported to increase chances of infant adiposity. The study has its significant shortcoming as; the research sample size is not stated. The article explains why the issue of obesity is prevalent in the young children. 

Title: Changing from primary to secondary school highlights opportunities for school environment interventions aiming to increase physical activity and reduce sedentary behavior: a longitudinal cohort study 

Type of study: a longitudinal cohort study 

Research has come up with very few links to the reduction of obesity and the transition of students from primary to secondary school levels. Also, the shift from one school to another has had a little impact on the sedentary behaviors and physical activity in the students. These may be linked to their lifestyle habits that may lead to adiposity in children. A total of 245 students from schools in Victoria, Australia were involved in the research to find out the link between the transitions and the effects on behavior that would directly or indirectly lead to adiposity or its reduction among the students (Marks, Barnett, Strugnell, & Allender, 2015). 

A total of 152 students (63%) of the 245 participants changed schools from primary to secondary in the region under study. Most of the students who changed schools were observed to have acquired new behaviors that were likely to reduce obesity than those who remained in the same schools. The transition between primary and secondary schools enables the students to learn new practices and lifestyles that are likely to reduce obesity (Marks, Barnett, Strugnell, & Allender, 2015). The article does not indicate the social influences on the students' behaviors as they move from one level of schooling to another. The article supports the PICOT question given. 

Title: Effect of intervention aimed at increasing physical activity, reducing sedentary behavior, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) School-based cluster randomized controlled trial 

Type of study: cluster randomized control trial 

The interventions in obesity have traditionally targeted the home-based care. Nevertheless, developments in the reduction of adiposity menace have found its way to interventions put in place at various schools in England. The objective of this research is to find out the efficiency of increasing physical activity and reducing sedentary tendencies among school children. Additionally, the vegetable and fruit consumption among the students will be included in finding out whether all the listed practices reduce obesity. A total of 60 primary schools with a total of 2221 pupils in the southwestern part of England participated in the research (Kipping et al., 2014). 

The AFLY5 school-based intervention was not effective in increasing the levels of physical activity, reducing the sedentary behavior among students and increase their level of vegetable consumption. There was no significant difference between the students under the intervention and the control group. The research stated that the other strategies of reducing obesity in the schools would necessarily be out in place to address the issue of obesity among the children (Kipping et al., 2014). One research limitation was that the research's focus on southwestern England was rather narrow. The article explains on the interventions that can be used to reduce obesity among the children, and therefore it addresses the PICOT question. 

Title: Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth 

Type of study: a systematic review 

The idea of moderate-to-vigorous physical activity (MVPA) has been highly embraced by some countries in the world as an effort aimed at promoting health among the students at different schooling levels. Therefore, the purpose of the research conducted in this case is to find out how physical activity is related to indicators of health among the students in school and the youth. A total of 162 studies were used from the online databases. The total number of participants was 204171 from 31 distinct countries. The age of the respondents ranged between 5 and 17 years (Poitras et al., 2016). 

Physical activity was associated with the physical and psychosocial well-being of the participants. Moderate-to-vigorous physical activity (MVPA) was advocated for in the findings. It was found that at least 60 minutes of MVPA per day was ultimately healthy and was proven to reduce the cases of diseases associated with obesity among the young people (Poitras et al., 2016). The major limitation of the research is that it encompassed a large number of people which means that the results were varied for better comparison. All the same, the study supports the PICOT question. 

Title: Incorporating Primary and Secondary Prevention Approaches to Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study 

Type of study: a systematic review 

The current level of prevalence of obesity in the state of Texas, the United States of America is raising a national concern albeit the sound strategies put in place by the United States government on the same. Apparently, it is necessary to include both primary and secondary prevention approaches to efficiently cover the issue of obesity, most importantly among low-income families in Texas. Baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project was collected for children aged 2-12 years and coming from financially challenged households. The children were obese and from the different ethnic groups in Texas, the United States of America (Hoelscher et al., 2015). 

Most children with obesity in the study came from Latino families whose income per year was less than or equal to $25000. They represented 73.3-83.8%. Among the respondents of the survey, 19.0% of the obese children were in preschool while 35.2% of them were in fifth grade. Due to the low-income of their parents, it was better to have school-based interventions to reduce the obesity levels in the children. Such ways would include physical activity (Hoelscher et al., 2015). All the same, the research does not indicate the actual number of children that were involved in the study. Moreover, the scope of the research is narrow since it focusses on the state of Texas while the rest of the United States of America is affected by cases of obesity. However, the study addresses the PICOT question. 

Title: Does Advertising Content Matter? Impacts of Healthy Eating and Anti-Obesity advertising on Willingness to Pay by Consumer Body Mass Index 

Type of study: randomized control trial 

In the modern world, advertising is one of the ways that are used to attract the attention of a large number of people at a given time. Essentially, technology has contributed to better advertising methods and platforms altogether. One of the examples of adverts that can move people is the one regarding healthy eating as a significant way of fighting obesity, a worldwide concern. The research was conducted to find out the efficiency of advertisement on the reduction of adiposity. A total of 183 respondents participated in the study. The respondents were divided into 3 random groups. One group was to be the control group with 60 participants. The second group was to be healthy eating advertising one with 63 respondents. The last group was to be a group advertising against obesity and would have 60 members (Wang, Liaukonyte, & Kaiser, 2018). 

The participants were categorized into two groups according to their BMI. The first group regarded normal weight was below 25 in BMI charts according to the world health organization, and the other group was referred to as overweight with a BMI above 25. Anti-obesity campaigns and advertisements for healthy foods for obese people are efficient. Conclusively, advertising tactics, when used correctly, serve to urge overweight people result in healthy diets (Wang, Liaukonyte, & Kaiser, 2018). One of the limitations of the research was that the study had a narrow scope of participants since the obesity menace is a global issue. The research addresses the PICOT question. 

Title: Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT 

Type of study: randomized control trial 

The role of counseling is a vital one to the contribution to healthier diets and reduced obesity cases in the world. In addition to the other measures of fighting adiposity such as physical activities and the reduction of the sedentary behaviors among the victims, dietary counseling is also fundamental. A research was administered to find out the role and effectiveness of motivation and counseling in the overall reduction of obesity. A total of 42 practices were adapted from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics and assigned into 3 different and random groups (Resnicow et al., 2015). 

After 2 years of follow up, group 1 had an adjusted BMI percentile of 90.3 while group 2 had 88.1 and group 3 87.1. The mean changes in the BMI percentile were 1.8 in group 1, 3.8 in group 2 and 4.9 in group 3. The motivational interviews offered by the dieticians resulted in the significant reductions in the BMI percentile. Such intervention reduces the cases of overweight children (Resnicow et al., 2015). Conclusively, the motivational dietary counseling is a useful tool in fighting adiposity. The research did not give the actual number of the participants who took part in the study. However, the study addressed the PICOT question. 

Title: HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children's sedentary behavior, and prevent obesity 

Type of study: randomized control trial 

Family-based care is one of the most fundamental components of the fight against children's obesity. This is mainly because the families have defined and unique ways of bringing up their children. The community also gets involved in the families' quest to reduce sedentary behaviors and subsequent obesity cases among children. The research was conducted to find out how the family and the community at large have been involved in providing better dietary solutions to prevent obesity among the children. A total of 81 families in Minneapolis, Minnesota were involved in the research. They all came from St. Paul. The children involved were 8-12 years old. Interventions and surveys were used to collect data (Flattum et al., 2015). 

The HOME Plus program's introduction into the families made them satisfied in their role in fighting obesity. The children and their parents remarked that the most exciting parts of the study were cooking together with the families and learning how to have healthy eating habits. In conclusion, Family-centered intervention programs such as healthy eating were proven to reduce obesity more among Minnesota's families, the United States of America (Flattum et al., 2015). The major limitation of the research is that the focus of the participants' inclusivity was narrow as it targeted a small portion of Minneapolis, Minnesota, St. Paul. The article, nonetheless, addressed the PICOT question. 

Title: Consumption of Specific Foods and Beverages and Excess Weight Gain among Children and Adolescents 

Type of study: a longitudinal cohort study 

The issue of adiposity has mostly been contributed by the kind of foodstuffs that those affected are having. Some specific foods have been found to have more fat and caloric contents leading to obesity among children and adolescents. A research was conducted to establish whether particular diets lead to obesity among children and adolescents. A total of 27 food and beverage groups and excess weight gain participated in the research. The groups included youths whose ages were between 7 and 13(Dong, Bilger, Van Dam, & Finkelstein, 2015). 

It was found out that some of the foods associated with a 3 years excessive weight gain were as follows. The first category was the fat-spread foodstuffs. The second category was coated foods. The third category was potatoes deep fried in oil. Sweetened beverages were in the other group (Dong, Bilger, Van Dam, & Finkelstein, 2015). In conclusion, obesity is heavily contributed to by foods with high fats and sugars in their caloric compositions. The scope of the research is in one country, the United Kingdom, while the effects of obesity are being realized in the other countries all over the world. The study explains the type of foods that are known to cause obesity among children. 

References  

Alberdi, G., McNamara, A. E., Lindsay, K. L., Scully, H. A., Horan, M. H., Gibney, E. R., & McAuliffe, F. M. (2016). The association between childcare and risk of childhood overweight and obesity in children aged 5 years and under: a systematic review. European Journal of Pediatrics , 175 (10), 1277-1294. 

Dong, D., Bilger, M., Van Dam, R. M., & Finkelstein, E. A. (2015). Consumption Of Specific Foods And Beverages And Excess Weight Gain Among Children And Adolescents. Health Affairs , 34 (11), 1940-1948. 

Flattum, C., Draxten, M., Horning, M., Fulkerson, J. A., Neumark-Sztainer, D., Garwick, A., … Story, M. (2015). HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children’s sedentary behavior, and prevent obesity. International Journal of Behavioral Nutrition and Physical Activity , 12 (1). 

Hoelscher, D. M., Butte, N. F., Barlow, S., Vandewater, E. A., Sharma, S. V., Huang, T., … Kelder, S. H. (2015). Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study. Childhood Obesity , 11 (1), 71-91. 

Kipping, R. R., Howe, L. D., Jago, R., Campbell, R., Wells, S., Chittleborough, C. R., … Lawlor, D. A. (2014). Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. BMJ , 348 (may27 4), g3256-g3256. 

Marks, J., Barnett, L. M., Strugnell, C., & Allender, S. (2015). Changing from primary to secondary school highlights opportunities for school environment interventions aiming to increase physical activity and reduce sedentary behaviour: a longitudinal cohort study. International Journal of Behavioral Nutrition and Physical Activity , 12 (1). 

Poitras, V. J., Gray, C. E., Borghese, M. M., Carson, V., Chaput, J., Janssen, I., … Tremblay, M. S. (2016). Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism , 41 (6 (Suppl. 3)), S197-S239. 

Resnicow, K., McMaster, F., Bocian, A., Harris, D., Zhou, Y., Snetselaar, L., … Wasserman, R. C. (2015). Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT. PEDIATRICS , 135 (4), 649-657. 

Wang, R., Liaukonyte, J., & Kaiser, H. M. (2018). Does Advertising Content Matter? Impacts of Healthy Eating and Anti-Obesity Advertising on Willingness to Pay by Consumer Body Mass Index. Agricultural and Resource Economics Review , 1-31.