Childhood obesity has over the years developed into a crucial health issue both nationally and internationally. Every country is going through a transition in terms of nutrition whereby most of the healthy foods with the relevant nutrients are not eaten this has led to the rise of chronic diseases and also obesity. Childhood obesity is more prevalent in children of developed countries especially in the United States. In the United States, obesity in the youth and the children has doubled its occurrence rate as compared to other developed countries (Ogden, 2010). According to current research, one in every three children are overweight and obese (Centre for Disease Control and Prevention, 2015 (Rollnick S, 2000)). This depicts that about 17% of the population of children and adolescents are obese. There are however some dissimilar aspects in the prevalence of obesity which are based on race, ethnicity and socioeconomic differences. According to the above statement, children who are Mexican-American and African-American and between the ages of six and eleven tend to be obese than children who are white (NHANES, 2008). 43% of the Mexican-American adolescents and children and 37% of the African-American adolescents and children are obese as compared to 32% of the white children (NHANES, 2008). Obesity usually strains the low income community this is because families that are characterized with low earnings face a tough time when dealing with obesity. These low income families face obstacles as a result of very low finances, lack of transportation, lack of access to proper healthcare and lack of access to better nutrition. Obesity occurs as a result of both societal changes and environmental factors. The societal changes include; an alteration in eating habits, lack of exercise in the lifestyle of people which has altered the energy balance meaning the amount of calories eaten exceed the amount of calories used. The environmental factors include; genetics, sleep and medication. This paper analyses and critiques the clinical practice guideline dealing with prevention and management of obesity for children and adolescents. The paper will be divided in the following portions, scope and purpose of the clinical practice guidelines, stakeholder involvement, rigor of development, recommendations, application and will finally look at the editorial independence.
Scope and purpose
The purpose of this Clinical Practice Guideline is to provide for nurses in all areas of healthcare with evidence based practice, education and policy recommendations for the primary prevention of obesity and overweight in children and adolescents. The guideline focuses on preventing obesity and overweight, the treatment and management of childhood obesity from when the child is an infant, joins preschool, joins elementary school, joins high school and finally joins university. The guideline is meant to apply to the following; allied health personnel, advanced practice nurses, dieticians, physicians, psychologists, health plans and hospitals. The purpose of this Clinical Practice Guideline is to provide for nurses in all areas of healthcare with evidence based practice, education and policy recommendations for the primary prevention of obesity and overweight in children and adolescents. The main health objectives covered by this clinical practice guideline are ; to increase the number and percentage of patients between the ages of 2 and 17 who are screened annually to determine whether they are obese or not using the Body Mass Index (BMI) and whereby the BMI percentile is determined. The other objective is to increase the number of patients between ages 2 and 17 who have an annual BMI screening and have received counselling sessions and have been educated on issues concerning weight management mechanisms which include exercising and good eating habits. The other objective is to increase the number of people between ages 2 and 17 with a BMI screening reading of 85 whose percentile has declined during the 12 month period when screening was being done . The targeted population are infants, pre-school children, elementary-school-aged children, high school adolescents and adolescents in colleges.
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Stakeholder Involvement
The aim of the guideline is to provide mechanisms in how to reduce and prevent the occurrence of obesity in children and teenagers. This guideline has dealt with different fields ranging from education, medication, surgery, behavioural aspects and alteration in the lifestyle of individuals, psychology, psychiatry, nutrition and endocrinology. The professions represented in this guideline include; a health dietician, a health promotion consultant, nurses, nutritionists, a family health specialist, paediatrician, endocrinologist and psychiatrists. The practices used are based on research from scientific works that are based on prevention and management of obesity for children and adolescents. The target audience’s views and preferences were considered and sought with ultimate concern and care this is because the effectiveness of this guideline depends on the organized and coordinated communication among the health practitioners applying this guideline and the children, the families of the children, the groups or communities associated with the children and the adolescents. The targeted audience was involved as they were required so that their Body Mass Index is determined. The basic Body Mass Index is very necessary when dealing with obesity as one is able to regulate the amount of fat in the body based on height and weight.
Rigor of Development
The systematic methods used to search for evidence include the following; meta-analysis or systematic reviews of randomized controlled trials, investigating at least one of the randomized controlled trials, investigating one well designed controlled study without randomization, investigating one other type of well-designed study resembling an experimental study without randomization, investigating well-designed descriptive studies that are not experimental which include; comparative studies, case studies and correlation studies and finally evidence is obtained from reports conducted by experts, opinions and clinical experiences from respected authorities in health practice. To collect the data required for the prevention and management of obesity for children and adolescents the methods used to collect or select the evidence also included conducting searches of the electronic databases. The criteria of selecting evidence for this guideline is based on whether the evidence was credible, whether the evidence was transferable and whether the evidence was complete (Rychetnik, 2006). The methods used were consistent and well defined which was necessary when conducting a literature search and review for the advancement and modification of Institute for Clinical Systems Improvement (ICSI) guidelines. The materials that were searched included for the recent version of the guidelines included paediatrics, children and childhood obesity which was published between November 2005 and March 29, 2013. Other materials used were systematic reviews, control trials, meta-analyses that are restricted to human studies. The data obtained was limited to certain topics discussed by the paediatrics, the paediatrics talked about prevention, screening, medication, gastric bypass and bariatric surgery. The quality of the evidence and strength of the evidence is of moderate quality this is because further research would lead to huge impacts and may even change the estimate. The process used for analysis of the evidence was reviewing of the published Meta-Analyses and by systematic reviewing with evidence tables. The method applied in validating the guidelines is conducting an internal peer review which was conducted in the following ways; a critical review process is performed and then the document is approved. The benefits for developing this clinical practice are to improve health outcomes, this guideline reduces morbidity and mortality and to ensure the quality of life of children and adolescents improves. Promoting and influencing public policy is another benefit of this clinical guideline. These benefits were considered as very impactful in the lives of the children and the adolescents. This clinical practice guideline was reviewed by experts through peer review consultation, invited peer review and public consultation. This guideline is updated by applying the following procedure; first of all identifying prospectively new evidence, then evaluating the original clinical practice guideline and then investigating whether the guideline requires the newly found evidence (Laura martinez Garcia, 2012)
Recommendations
The major recommendations arising from this guideline are that; first and foremost, obesity awareness should be directed towards every family immediately a child in the family is born. The Body Mass Index should be measured and tabulated or recorded in a medical record on every child between the ages of 2 and 18 at least once a year during a check-up. Doctors and nurses should examine the children by reviewing of the systems and also through physical examination in an effort to determine whether the child has any obesity related comorbid conditions (Barlow, 2007). Those suffering from obesity or overweight should be introduced to management intervention strategies which are; nutrition, exercising, changes in behaviour and changing their lifestyle. The clinicians should promote motivational interviewing techniques as a way to enhance changes in behaviour (Rollnick, 2000). Those suffering from obesity and overweight and their families should be advised on nutritional interventions whereby beverages filled with sugar are struck out together with fatty processed food (Barlow, 2007). They should be encouraged to consider nutrient filled meals. In weight management every individual should be told that they cannot achieve their goals alone but they require a team approach. The patient should ensure that they have an on-going relationship with the health care personnel who treat the patient. All public health researchers and health practitioners concur that the procedures outlined in this guideline are the best in preventing overweight and obesity.
Application
In application of these guidelines there are some benefits that arise as a result of following them and there are also some negative effects that have arisen from following these guidelines. The benefits are that once these guidelines are followed there is effective prevention and efficient management of obesity and overweight in children and adolescents. The negative effects include injuries that occur as a result of exercise. Weight loss medications also have some side effects which include cramping of the abdomen, oily bowel movements, and oily stains on underwear. Other side effects include diarrhoea, nausea and flatulence. Another negative effect is as a result of bariatric surgery whereby the Roux-en-Y gastric bypass experiences risks such as small bowel obstruction, bloating, vomiting, anastomotic leak, protein calorie malnutrition. The contraindications as a result of applying these guidelines are that; pregnant, or those adolescents who plan to get pregnant within a duration of two years cannot be subjected to bariatric surgery.
Editorial independence
The author during the formation of these guidelines tries to provide studies, scientific research and systematic research reviews that promote the experimental evidence that has been applied in the prevention of obesity and overweight in children and adolescents hence leading to conclusive information. Some of the conflicts that arise as a result of different research institutions or organizations occur because of the interest of other factors which include; money obtained from publication rights or high returns from research grants. One of the conflict of interest that might arise is the authors of this guideline may tend to be bias and end up writing their own views when it comes to the evidence obtained because they would like their opinion to be viewed as correct. In spite of whichever the interest is in this topic, the authors of this guideline were advised on the importance of this guideline as it was based on promoting the well-being of the society and it aids in achieving better healthcare when preventing and managing obesity.
Summary
In re-evaluating what has been analysed, this clinical practice guideline addresses the aspect of how to prevent minors and teenagers from becoming obese and if they are obese, this guideline provides a mechanism of how to manage it. In order to apply this guideline there is need for a high level of experience by the nurse. The research conducted in formulating this guideline was collected and analysed under excessive scrutiny to obtain the best results. The standards of practice from the guidelines are based on experimental exercise obtained from evidence based practice. This clinical guideline procedure will be applied with critical observance of each guideline laid out in the procedure in order to achieve the maximum from the procedure. This will be done by first ensuring that every child that is treated under my care will have their Body Mass Index measured, tabulated and recorded, I will also ensure that the children and adolescents are physically examined to determine whether any child has any obesity related condition. Those who are found to be suffering from obesity or overweight will be introduced to management intervention strategies. I would also encourage the patients to live a more active lifestyle.
References
Fitch A, F. C.-D.-B. (2013). Prevention and management of obesity for children and adolescents. Institute for Clinical Systems Improvements , 94.
Laura martinez Garcia, I. A. (2012). Implementation Science. Strategies for Monitoring and Updating Clinical Practice Guidelines , 109.
Ogden, C. (2010). Prevalence of High Body Mass Index in US children and Adolescents. PubMed .
Prevention, C. f. (2015, September 14). Overweight & Obesity . Retrieved february 16, 2017, from Data & Statistics: https://www.cdc.gov/obesity/data/index.html
Rollnick S, M. P. (2000). Educ for Health. Health behavior change: a guide for practitioners , 415.
Rychetnik, F. H. (2006). Criteria for Evaluating Evidence on Public Health Interventions. Journal of Clinical Pathology .
SE, B. (2007). Expert Comittee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity , 120.
Statistics, N. C. (2016, october 5). National Health and Nutrition Examination Survey . Retrieved February 5, 2017, from https://www.cdc.gov/nchs/nhanes/nhanes2007-2008/manuals07_08.htm
