Running head: INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 1

Involving Physical Activity Among Children to Reduce Obesity and Promote Healthy Lifestyles

Rebeca Alba, Anne Baptiste, and Taylor Brashears

University of South Florida

INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 2

Abstract

Clinical Problem: According to Tuckson (2013), childhood obesity has tripled from less than 5%

to nearly 20% , and about 32 % of US children are either overweight or obese. Children who are

inactive have increased health risks such as trouble breathing, high blood pressure, low self-

esteem, and joint problems.

Objective: The objective of this synthesis paper is to discuss how the involvement in physical

activities, compared to no physical activity involvement, promotes a healthy lifestyle, and

reduces the chances of childhood obesity. The databases PubMed and CINAHL were used

to access the randomized controlled trials (RCT) in nursing pertaining to

using physical activities to reduce childhood obesity and promote healthier lifestyles. Key search

terms included childhood obesity, physical activities in afterschool programs, early interventions,

and healthier lifestyles in children.

Results: In obese children ages 6-12, there was a reduction in body mass index (BMI) when

children were physically active, and following a consistent dietary plan as compared to living a

sedentary lifestyle. Benestad et al. (2017), demonstrated a decrease in BMI in children who

attended a 2-year summer camp based family treatment program (p< 0.01). Larson et al. (2016)

demonstrated an increase in weight loss and physical fitness activities through an immersive

childrens day camp intervention program (p= 0.01). Slusser et al., discovered that increased

opportunities for physical activities in after school programs provided more opportunities for

success in improving obesity in children (p= 0.009).

Conclusion: Although providing children with opportunities to participate in physical activities

can decrease BMI, further research is needed to confirm whether it is enough to maintain a
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 3

continuous healthy lifestyle, and prevent adult obesity. Also, further research should be

conducted on whether including the child family plays a role in their success or failure.

Introduction

Physical activity is an essential part of a childs health because without some form of

physical activity obesity and health risks occur. Obesity has increased over the last 30 years and

more than 17% of children in the United States are obese which increases the risk of morbidity

and mortality in adults. (Ogden, Carroll, Kit, & Flegal, 2014). As society has become more

technologically advanced, and unhealthy food has become more accessible, physical activity

among children has decreased. There is a need, in the United States, for weight-loss

interventions that are effective and sustainable for children. Healthy eating is used as a current

clinical practice for preventing childhood obesity, but continued participation in physical activity

has been proven to decrease the risk of childhood obesity and promote overall health. Physical

activity of 150 to 300 minutes of moderate-intensity activity is recommended and has been

shown in randomized control trials (RCTs) as an important part in achieving both short and long-

term weight loss success and promoting a healthy lifestyle (Slusser, Sharif, Erausquin, Kinsler,

Collin, & Prelip, 2013). Therefore, these RCTs reveal in children ages 6-

12, how the involvement in physical activities compared to no involvement promote a healthy

lifestyle and treat obesity, over the course of 2 years.

Literature Search

Databases PubMed and CINAHL were used to access the nursing RCTs pertaining to

using physical activities to reduce childhood obesity and promote healthier lifestyles. Key

search terms included childhood obesity, physical activities in afterschool programs, early
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 4

interventions, and healthier lifestyles in children. The publication years searched were 2012 to

2017.

Literature Review

Three randomized controlled trials (RCT) and one clinical guideline were used to assess

the efficiency of using physical activity to reduce childhood obesity. Benestad et al.

(2017) compared the effectiveness of a 2-year camp-based family treatment program on

childhood obesity. This RCT study measured the two-year changes of Body Mass Index (BMI)

reported using z-scores among 90 obese children with a BMI >30 aged 7-12 years with a z- score

above the mean. Data were analyzed using a linear mixed model approach. Study data were

analyzed over the entire course of the 2-year study using instruments such as scales, rulers to

measure heights, blood samples. The patients were randomized into an intervention group

(n=46) or a control group (n=44). The intervention group consisted of a summer camp group

who underwent an initial 2-week program at a private rehabilitation institution enforcing

physical activity with four follow-up weekends (2 days at 6, 12, 18 and 24 months). The control

group consisted of a lifestyle-school group who attended 4 days (with a total of 23 hours) in the

outpatient clinic over a period of 4 weeks in 24 months to monitor health status and compare the

changes of an active lifestyle versus a sedentary daily lifestyle in obese children. The primary

study outcome was the 2-year change in BMI standard deviation score(SDS). In addition, the 2-

year changes in BMI were compared between intervention and control groups, and the children

were categorized into those achieving a reduction in BMI SDS of 0.25 and 0.50 versus those

who did not. Compared with children in the lifestyle-school group, the outcome showed that the

summer-camp children had significantly lower increases in fat mass (2.4 kg) over 2 years, and a

larger decrease in waist-to-height ratio. The summer-camp children had a significantly lower
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 5

increase in BMI units (0.8 kg/m2) than those who underwent the lifestyle-school

(inactivity) of p< 0.01. This RCT demonstrated that physical activity decreased the likelihood of

childhood obesity, as compared to children who were less physically active, resulting in a

healthier, and more active lifestyle. Strengths for this study were that children were randomly

assigned to the experimental and control groups, random assignment was concealed from both

the children and their parents, there were reasons given to why families and children did not

participate, follow-up assessments conducted were long enough to study the changes of BMI

between both groups, the subjects were analyzed in their assigned groups, the control was

appropriate to compare to intervention group, the instruments were valid and reliable musing

standardized measures of BMI, body fat percentage, fat mass, and body weight, and the subjects

had no significant differences and they all had a BMI of > 30. Lastly, a weakness for this RCT

was that Investigators were not blind to the study group assignment.

Larson et al. (2016) determined how an engaging children day-camp intervention

program, with a main focus of weight loss, also influences the improvement of motor skills and

physical fitness, in obese children, when compared to a low-intense standard

intervention program. The studys design was a randomized controlled trial (RCT). This study

included measures of obesity, motor skills, and physical fitness. Self-assessment of Tanner

stages approach measured the engaging treatment strategies in which obese children are removed

from their obesogenic surroundings and placed in therapeutic and educational environments.

This strategy included participation in the intervention program, which involved physical

activity, in order to support the sustainability of the weight loss achieved by the

participants. Physical fitness was assessed by hand grip strength, vertical jump, and an ongoing

cardio-respiratory fitness test. Motor skills were assessed using the Movement Assessment
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 6

Battery for Children techniques. The sample size was 106 obese children ages 11-12 with a BMI

>25. The patients were randomized into an intervention group (n=55), a Day-Camp Intervention

Arm (DCIA), followed by a family-based support program or a control group (n=51), a low-

intense Standard Intervention Arm (SIA). Each day of the daytime camp, children were involved

in physical activity classes including a minimum of three hours of organized exercise with a

focus on physical activity motivation (ex: team building, dancing, and different ball-

games). Body weight was measured on a Soehnle Professional Medical electronic scale. The

study proves that both physical fitness (PF) and motor skills (MS) affect the level of physical

activity in obese children and plays a huge role in their weight loss. Evidence also suggests that

the failure to attain an essential basic level of MS may contribute to a decline in PA during

adolescence, therefore affecting their health promotion. Moreover, PF contains the basics of

performance-related fitness (ex: balance and power) and health-related fitness (ex:

cardiovascular fitness and muscular strength). Therefore, if obese childrens performance in PF

and MS can be coerced during a daily weight-loss intervention program, the chances of

consistent and sustained weight loss through increased engagement in physical activities would

increase in obese children. The intervention group had an increase in physical fitness such as

compared to the control group (p=0.01). Both groups remained unchanged in motor skills in both

6 and 52-week marks p=0.02. Strengths for the study were that the subjects were randomly

assigned to a control group and an experimental group, the assignment was random and

concealed from the participants in the study, the reasons for inability to complete trial were

given, the follow-up assessments were completed at a long enough time to fully study the impact

of the weight loss program, the students were analyzed in the random groups that they were

assigned, the instruments were valid and reliable, the control group was appropriate because they
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 7

still received some type of weight loss intervention, and the subjects did not have any significant

differences. Lastly, a weakness was that the testers were not blind to the study.

Slusser et al. (2013) discussed the ways to enhance after-school physical activity

opportunities through evidence-based programs to potentially improve obesity and overweight

in children. The design of the study was a randomized controlled trial (RCT). This study

measures BMI with scales, rulers, and growth charts. Other measures included attitudes, physical

activity knowledge, and behaviors associated with the program. The sample size was 121

overweight and obese children ages 6-11. The patients were randomized into an intervention

group of a health promotion curriculum (n=48) or a control group of a normal school curriculum

with no after school physical activity promotion (n=73). The curriculum in the intervention

group included orientation and training on physical activity and nutrition education through the

Catch Kids Club curriculum. Catch Kids Club is an evidence-based program that is designed to

teach students the skills to make physical activity and healthy dietary choices at school, at home,

and in the community. Youth specialists were trained to increase the students opportunities to

engage in moderate to vigorous physical activity. This was an intervention curriculum that took

place from grades 3-5. Data for this intervention was collected at baseline, in September, and at

follow-up which was the end of the school year in June. Regarding nutrition knowledge,

attitudes, and behaviors, there was a significant statistical difference in the in the increase of the

childrens nutritional knowledge over time (p=0.009) as well as a significant decrease in junk

food consumption (p=.035) between the control groups and intervention. There were little

statistical differences between the intervention and the control groups regarding physical activity

knowledge, attitudes, or behavior. Regarding BMI, the intervention group had significantly

greater decrease compared to the control groups. The percentage of obese children decreased by
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2.0% (from 46.7% to 44.7%) among the comparison group (p=0.000) and 3.1% (from 40.6% to

37.5%) among the intervention group. This RCT demonstrated that children who engage in after

school physical activities have a decreased risk of being obese than those students who

participate in no activities. Strengths of this RCT included that the students were randomly

assigned to control and experimental groups, random assignment was hidden from individuals

who were enrolling students into the study, and there were reasons given as to why students did

not complete this study. Two students withdrew and sixteen were removed because of

implausible values and missing data for height and/or weight. More strengths included follow-up

assessments conducted were long enough to see a significant change in both nutritional

education and BMI, the subjects were analyzed in their randomly assigned groups, the control

was appropriate to compare to the intervention group, and he subjects had no statistically

significant differences. Lastly, weaknesses for this RCT included Youth Specialists and Program

Leaders were not blind to the study, and although BMI was a reliable instrument, they could

have included a physical assessment to see how the students have improved.

The National Guideline Clearinghouse (2013), has determined that childhood obesity is a

widespread health problem in the majority of developed countries. This guideline encourages an

assessment of physical activity, diet, and inactive behaviors preferably at each well-child visit to

target appropriate messages to each family about obesity prevention (The National Guideline

Clearinghouse [NGC], 2013). They also recommend that children get at least 60 minutes of

moderate exercise daily (NGC, 2013).

Synthesis

The evidence shows that physical activity significantly reduces obesity in children and

promotes their overall health. The randomized control trials conducted by Benestad et al. (2017)
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 9

demonstrated the children in the intervention group had a lower increase in BMI compared to the

control group (p< 0.01). This result indicates that performing physical activity for at least 60

minutes per day increases the success rate of weight loss. In addition, Larson et al. (2016)

determined the intervention group had a significant increase in physical fitness (p= 0.01). The

result demonstrates that introducing moderate physical activity into the childrens daily routine

has a positive effect on their level of physical fitness. Due to this increased activity tolerance and

ability to perform exercise, the childrens obesity is likely to improve, as shown in Benestad et

al.s results. Slusser et al., similar to Benestad et al., concluded that the intervention group had a

substantial decrease in BMI compared to the control group (p= 0.009). This result from the study

shows that moderate to vigorous activity promotes weight loss, therefore reducing obesity and

increasing the overall health of the child. All of these findings support the clinical protocol from

the National Guideline Clearinghouse, which states children should exercise for a minimum of

60 minutes per day to obtain a healthy BMI and improve overall

health.

The major weakness of all three studies was the fact that the investigators were not blind

to the study. Due to this, there is a potential the investigators were biased towards a particular

group. Although unlikely, this increases the likelihood of skewed results since the investigators

had the opportunity to influence one group or the other to achieve certain results. To ensure the

results are unbiased, further studies need to be conducted with masked investigators.

Clinical recommendations

Research suggests that physical activity may be an effective practice to promote a healthy

lifestyle and treat obesity. A guideline was established for physical activity specifically related

to obese children, guiding their parents and health care providers in ways to aid and increase
INVOLVING PHYSICAL ACTIVITY TO REDUCE OBESITY 10

their chances of success. Research confirms that at least 60 minutes a day of physical activity

helps decrease the body mass index in obese children, therefore improving their obesity and

promoting a healthier lifestyle. Further research needs to be conducted to determine if family

involvement alongside physical activity plays a role in the success or failure of obesity reduction

in children.
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References

Benestad, B., Lekhal, S., Smstuen, M. C., Hertel, J. K., Halsteinli, V., degrd, R. A.,

& Hjelmesth, J. (2017). Camp-based family treatment of childhood obesity:

Randomized controlled trial. Archives of Disease in Childhood, 102(4), 303310. doi:

10.1136/archdischild-2015-309813

Larsen, K. T., Huang, T., Larsen, L. R., Olesen, L. G., Andersen, L. B., & Mller, N. C. (2016).

The effect of a multi-component camp-based weight-loss program on childrens motor

skills and physical fitness: a randomized controlled trial. BMC Pediatrics, 16, 91. doi:

10.1186/s12887-016-0627-5

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of Childhood and

Adult Obesity in the United States, 20112012. JAMA, 311(8), 806

814. http://doi.org/10.1001/jama.2014.732

National Guideline Clearinghouse (NGC). Guideline summary: Prevention and management of

obesity for children and adolescents. In: National Guideline Clearinghouse (NGC) [Web

site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2013 Jul

01. [cited 2017 Oct 08]. Available: https://www.guideline.gov

Slusser, W. M., Sharif, M. Z., Erausquin, J. T., Kinsler, J. J., Collin, D., & Prelip, M. L. (2013).

Improving Overweight among At-risk Minority Youth: Results of a Pilot Intervention in

After- school Programs. Journal of Health Care for The Poor &

Underserved, 24(2, Supp), 12-24. doi: 10.1353/hpu.2013.0111

Tuckson, R. V. (2013). America's Childhood Obesity Crisis and the Role of Schools. American

School Health Association.

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Word Count:

Rebeca: 770 words

Anne: 770 words

Taylor: 770 words

Total: 2310 excluding cover and references pages