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Childhood Obesity
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Relationship between Childhood Obesity and Contributing Factors
Sharon Cummings
University of North Carolina at Pembroke
Childhood Obesity
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Abstract
Childhood Obesity is one of the leading causes of childhood illness in America and foreign
countries. Childhood Obesity has been associated with life threatening diseases such as: High Blood
Pressure, Diabetes, Cardiovascular Disease, Depression and more. Research has discussed several
factors that are considered to contribute to Childhood Obesity. The factors that will be discussed in
this research proposal study are: race, gender, age group and social class. In addition, this research
proposal study will specify ethical, moral, and media influences on Childhood Obesity. Methods are
discussed throughout the research proposal study to promote prevention and intervention programs
that include a healthy and active lifestyle. It is imperative that educational settings as well as the
community incorporate prevention and intervention programs at an early age. Prevention and
intervention programs need to include educational settings as well as the community. This research
proposal study was written to enlighten readers on the importance of prevention and intervention
programs for children to fight against Childhood Obesity.
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Introduction
In today’s society, many of our young children are facing a serious problem. That problem is
childhood obesity. This issue is so foreboding it’s drawn the attention of First Lady Michelle Obama
who is an advocate for issues relative to childhood obesity. Mrs. Obama has also created “Let’s
Move”, an initiative aimed at encouraging children to become more active (letsmove.gov).
As
evident, an unhealthy diet is not the only factor contributing to childhood obesity. Other factors that
also influence this growing dilemma include the media and direct advertising targeting children,
restaurants offering larger portions or super-sized meals, limited lunch choices in the school systems
with poor nutritional value as well as lack of exercise and physical exertion.
Purpose of the Study
The purpose of this study is to analyze various factors that contribute to the likelihood of a
child becoming obese and to discuss preventive measures that can decrease excessive childhood hood
weight. This research will focus on the following demographics: race, gender, age group and social
class. Also, this research will detail ethical and moral ramifications of media influence, methods for
promoting a less sedentary lifestyle and various options for educational institutions.
Statement of the Problem
Childhood obesity is a dire problem that if not addressed early will have a negative impact on
a child’s social, emotional and physical wellbeing.
Therefore, it is best to begin intervention
programs as soon as possible. Early intervention is the key to success in battling obesity in children.
Collaboration with the media, in the home and in schools will ensure healthy children with limited
issues relative to weight. The media bombards children with advertising that entices them into
harassing the parents for meals that are not suitable.
Parents, who are often overwhelmed with job burdens, financial concerns and often health
issues of their own, find it easier to give children what they are requesting. Finally, schools serve
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foods that are high in calories and low in nutrition. All these problems combined create a perfect
atmosphere for obesity.
Rationale for the Study
Minority populations at higher risk include: Hispanics/Latinos, African-Americans and Native
Americans. These ethnic groups present a greater risk of insulin resistance syndrome, cardiovascular
problems, physical, emotional, and social disorders. In addition, to these issues they are often come
from low income households. According to the statistics for “childhood obesity are staggering; 13%
percent of Caucasian overweight youth, 24% percent of African American, 24% percent of Mexican
American, and 20% of Non- Hispanic African American are overweight and an estimated 39% of
Native American youth are at risk of being overweight (Wieting, p.546, 2008)”.
Childhood obesity is a serious problem that has been addressed at the national level. However,
their efforts to educate the public are reaching communities too slowly, especially in diversity
communities. Obesity not only affects children in the stages of their youth and adolescence, but also
can cause physical and psychological impediments once they reach adulthood. Education about
childhood obesity is critical for all obese children especially during the first years of their lives.
Research Question/Hypothesis
The research question for this research proposal study is: What is the relationship between
Body Mass Index and school lunches? The research question was developed based on research that
the majority of children eat school lunches twice a day plus a snack. The hypothesis is that lunches
are not as healthy as should be therefore, school lunches contribute to childhood obesity. There is
evidence directly linking childhood obesity to the media, parental guidance, demographics and school
lunches. According to Whitmore-Schanzebach “almost two-thirds of school children participate in a
National School Lunch Program lunch and one-third of their daily calorie intake is consumed in this
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lunch. Unfortunately, “most of these meals are also low in nutritional value and may be the only meal
that child consumes that day (Whitmore-Schanzebach, para.1, 2005)”. There is evidence directly
linking Childhood Obesity to the media, parental guidance, demographics and school lunches.
However, “children who have cafeteria food actually eat an additional 40-120 calories per day
compared to those who bring a lunch from home (Whitmore-Schanzenbach, para.1 2005)”. Because
of the increased calorie intake students who eat school lunches are more likely to become obese.
Literature Review
Introduction
Childhood obesity is not a new problem, but over the past thirty years the obesity rates have
significantly increased. According to research “at early ages children are being diagnosed with
physical health disorders such as: diabetes type 2, high blood pressure, abnormal glucose tolerance,
asthma, sleep apnea; they are also prone to suffer from the following psychological and emotional
issues such as low self-esteem, eating disorders, anxiety, depression, etc, (CDC, para.5, 2009)”.
Without the proper prevention and intervention techniques these children face a life of despair. It is
up to the parents and school officials to educate children about living a healthier lifestyle and the
media to accept responsibility for influencing children’s unhealthy decisions geared at over
consumption.
History of Childhood Obesity
While this problem may seem to become a major concern as of today, it dates back way
further than that. According to the Center for Disease Control, “the trends of childhood obesity were
first studied from 1963-1965, the increase in childhood obesity would increase over the following
years; 1976-1980, 1999-2000 and 2007-2008 (CDC.gov, 2010, para.1 & 2, 2010)”. There has been no
significant change in the childhood obesity rate since this article was published in 2010. It is no secret
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that things have dramatically changed over the past few decades. Now more than ever American
households rely on fast food options; while 30 years ago many households ate more balanced home
cooked meals.
Within the years “1998-2008 one of 7 low-income, preschool-aged children was obese, but
the obese epidemic may be stabilizing; the prevalence of obesity in low-income two to four year olds
increased from 12.4 percent in 1998 to 14.5 percent in 2003 but rose to only 14.6 percent in 2008
(CDC.gov, 2010, para1 & 2)’’. In today’s society individuals work longer hours or may be on a fixed
income and rely on fast-food options to meet their nutritional needs. On a national level the United
States is one of the leaders in obesity of children and adults as well. On a local level, “North Carolina
is ranked #14 in the nation in childhood obesity and #12 in the nation for adult obesity
(healthyamericans.org 2009, par1)”. It is obvious that childhood obesity has a direct correlation with
facing obesity as an adult.
For instance, “in one study found that approximately 80% of children who were overweight at
age 10-15 years were obese adults at age 25 years (CDC.gov, 2010, par 4)”. By experience whenever
there are obese parents, usually the children are obese as well. According to “national statistics the
southern states lead highest in childhood obesity than their northern counterparts (CDC, 2009, par4)”.
Apparently the southern states may not be aware of these statistics, because there is no immediate
action taken place to reduce obesity in these areas. The southern states should be more aware that
they are at a higher rank for obesity than the northern states and, more prevention/ interventions are
needed to help correct this epidemic.
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Comparison and Contrast of Previous Research
Influence of the Media
Charlene Elliott, Ph.D. has researched childhood obesity through the socio-cultural studies. Dr.
Elliott has created solutions that strive to deal with problems associated with over consumption of
food. Elliott’s research is focused towards the media. The media has a way of enticing children to
persuade their parents to buy these foods that are full in high fat and high in sugar. Therefore, many
children are lured into consuming these foods. The media also captures the attention of young
children through enticing prizes. Elliot’s research has found that “there is focus on supermarket food
and the package of “fun” (Elliot, 2005, par 6)”.
Children are enticed by what the packages may include such as children’s favorite characters,
different shapes and colors to make the packages more appealing to children. Therefore, in return the
children are adamant to their parents to purchase these unhealthy foods. However, “as education
practitioners, knowledge of the messages in and around supermarket food may help us to gain a more
complex understanding of the social environment contributing to childhood obesity (Elliot, p. 21,
2005)”.
Children spend on average five and a half hours watching television sitcoms, cartoons, movies,
playing video games, using the computer and cell phones for pleasure. It is no surprise that fast food
outlets spend billions of dollars yearly on commercials promoting their unhealthy foods. On a daily
average children are exposed to an average of one food commercials every five minutes- forty
thousand television commercials annually; most of these commercials are for candy, high sugar
cereals and fast foods (Wieting, 2008, par 16)”. These types of commercials are usually aired during
children’s favorite television shows. Very seldom are there commercials about fruits, vegetables and
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dairy products. The media has a way of tantalizing children to try their products. According to Let’s
Move program since children spend a great amount of time watching television or play computer
games “break it up by using commercial breaks as a way to get active by doing the following:
jumping jacks, dancing, sit-ups, stretching, jogging in place etc.(CDC.gov, 2009, par 1)”. This is a
great way to incorporate fun and staying healthy all at the same time. Parents should be adamant
about this until the child clearly understands that when commercials are on exercise will become more
of a routine. Hopefully the child will enjoy doing these exercises and will continue to do them
without being told to do. On Wednesday April 13, 2011, the researcher noticed a talk show that was
aired at 11:00 a.m. est. called the View; briefly the discussion was about unhealthy school lunches and
how these lunches need to be more nutritional. The talk show discussed how children were obese and
how Obama was encouraging better eating habits more exercising to help alleviate Childhood
Obesity. The media should air more encouraging discussions about this topic nationally.
Prevention and Intervention
Research with CDC suggests that “schools and school districts are increasingly, implementing
innovative programs that focus on improving the nutrition and increasing physical activity among
students (CDC.gov. 2009, par 9)”. This is a great start to target one of the main sources of Childhood
Obesity and implement programs that will work. Advocating in the local communities for health
clubs where children can go to exercise and have a nutritionalist on hand to educate healthier eating
and drinking habits. The researcher may have participants to make a list of what they have eaten/
drink on a daily basis to determine what changes need to take place in their diets. If these goals are
accomplished then the Childhood Obesity rate should decline.
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Larger Portion Sizes
Other researchers claim that “changes in diet due to bigger portions leads to pediatric obesity;
food outlets have more than doubled over the past two decades, in addition to a baseline increase in
portion sizes, most fast food restaurants offer 20% larger portion sizes for minimal additional cost
adding hundreds of extra calories (Miller, Rosenbloom &Silverstain,2009, par 5)”. Most individuals
will purchase bigger portions for their children because; they may feel that they are getting their
monies worth. In a sense individuals believe that they are getting more food at little cost but, they are
not aware of all those extra unhealthy calories that will be consumed. However, around thirty years
ago “super size” was not on the menus and, children usually ate their appropriate portions. It was a
pleasure to be able to eat snacks and fast foods during this time. Today children are apt to eat more
because parents do not monitor food, sugar or calorie intake.
Nutritional Value
Another contributing factor of obesity among children is sugar-sweetened beverage.
According to The Centers for Disease Control and Prevention “researched that evidence is limited on
specific foods or dietary patterns that contribute to excessive energy intake in children on the other
hand; eating meals away from home; frequent snacking on energy-dense foods and consuming
beverages with added sugar are often hypothesized as contributing to excess energy intake of children
(CDC.gov, 2009, par 4)”. Children have little knowledge of calorie intake therefore; children will eat
foods high in calories that will produce a boost of energy only to be hungry in a short time later.
Children believe that these foods are tasty but, are uneducated about how unhealthy they are.
According to Wieting “fast –food outlets alone spend three billion dollars per year in advertisements
targeted toward children (Wieting, 2008, par 16)”. McDonald’s commercials often seem appealing to
a child, spending that special time with their parent/s and looking forward to eating fun but unhealthy
Childhood Obesity
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The child sees how easy and quick it is to just go “grab” a happy meal, rather than make a
nutritional meal with their parents. These fast food commercials rarely show the importance of
making healthy food choices at restaurants.
In contrast, adolescents from previous decades spent less time indoors and maintained a higher
level of physical activity.
The Centers for Disease Control and Prevention (CDC) reports that
“physical education among adolescents dropped 14 percent over the past 13 years (CDC.gov, 2009,
par 6)”; with this decaling percentage it is more likely to progress further without adequate
motivation.
Therefore, parents play an important role in their children’s lives. From experience,
children are most likely to develop habits from their parents. Parent’s actions can play a role in the
child’s behavior relating to ethics revolving around weight, health and nutrition. Families at one time
did spend more time together especially during meals reinforcing healthy lifestyles. Whereas today
families seldom eat their meals together because most times it is difficult to gather everyone together
at the same time. Therefore, the idea “eat what you can, when you can” whenever the time is
permissible for that individual.
During the “past four decades the obesity rate for children ages 6 to 11 has more than
quadrupled, from 4.2 percent to seventeen percent, and more tripled for adolescents twelve to
nineteen, from 4.6percent to 17.6 percent; a substantial body of research has determined that increased
sugar-sweetened beverages (SSB) consumption leads to excess weight gain and a higher risk of
obesity among youth (Robert Wood, 2009, par1)”. Today children consume very little milk or water
which is essential for body growth. It is obvious that drinking plenty of milk gives the body vitamin
D and, helps to strengthen bones, teeth, and retain calcium. Calcium is vital for the body “without
proper milk intake girls are at higher risk than boys for lower bone mineral density and increased risk
of bone fractures (Robert Wood, 2009, par 5)”.
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Water intake is necessity for living; without adequate water the body would dehydrate and
parish. According to the “Let’s Move” imitative, you can drink the following: 100% juice without
added sugar, 1% skim milk, add slices of fruit to make water more favorable (letsmove.org, 2001, par
1)”. Drinking plenty of water will help to keep the body regulated, loose calories and clear skin. The
part about water is that it’s free and does not require an exurbanite income to consume.
Childhood obesity among Race and Gender
Obesity among children affects different races as well as gender. Among the different races
there is a “great increase in prevalence currently seen among African American, Hispanic, and Native
American and children (Wieting, 2008, par 9)”. There is a great need to reach out to these diversity
groups and research why they are among the top highest for childhood obesity. Those individuals
who are from diversity groups lack the education needed to prevent obesity among children, it is
essential that these groups of individuals receive the key tool which is education to reduce childhood
obesity among their selves.
Researcher Naomi Weinshenker, M.D., who is an Assistant Professor of Clinical Psychiatry at
the NYU School of Medicine, has interest in Body Dysmorphic Disorder, anxiety disorders and the
psychosocial aspects of obesity conducted research on adolescence girls and boys. Among this
research was “Body Dysmorphic Disorder (BDD), this term means an intense preoccupation with an
imagined or slight defect in one’s appearance, appears to have onset in adolescence or young
adulthood and often coexists with other psychiatric conditions such as social anxiety disorder,
obsessive-compulsive disorder and atypical depression (Weinshenker, 2002, par 14)”.
Most young boys and girls are very self-conscious about their bodies. Many young boys want
a nice muscular physique as well as many young girls who want that slender flawless physique and,
usually along with this so called perfect body their self- esteems are at most high. However, “girls
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who are unable to identify the societal values that are detrimental to their development needs, and who
identify with the idea image are at risk for eating disorders (Weinshenker, 2002, par 9)”. Therefore,
those girls who are not pleased with their body image may turn to anorexia or bulimia which can
result in serious physical and mental consequences. On the other hand “boys who are not pleased
with their body image are prone to “reverse anorexia” which is muscle dysmorphia involving a
preoccupation with the idea that one’s body is not sufficiently lean and muscular; the thoughts are
instructive and associated with a great deal of anxiety, and the activities (i.e. weight lifting) can be so
time consuming that school, work and social life are pushed aside (Weinshenker, 2009, par13)”.
From personal knowledge boys who are so desperate to have that muscular physique maybe
susceptible to engage in the use of steroids or other dangerous illegal drugs that will enhance the
body. Therefore, girls and boys appear to be equivalent in not being pleased with their bodies or they
may suffer from BDD syndrome. These young people are at a higher risk of developing serious
disorders such as anxiety, depression and more social and behavioral problems.
Research from Newman & Newman asserts that “adolescent’s girls have concerns about their
bodies being too fat; this concern is not so much that being overweight is unhealthy, but that it results
in peer rejection form both boys and girls (Newman & Newman, p. 322, 2009)”. It is by knowledge
that young girls do not see risk factors of being obese; they only want to fit into groups, cliques and
just to be accepted by their peers. This is distressing that these young boys and girls have to deal with
this situation and do not understand that it is vital to know that there are preventions and interventions
programs that can help.
In one study “three hundred sixty-six kindergartens-through-second grade children from three
Wisconsin Native-American reservations participated in health screenings consisting of height, hip
and waist circumference, triceps and sub- scapular skin-fold thickness, blood pressure, and finger
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stick blood draw for glucose, total cholesterol, and high density lipoproteins were the main focus for
BMI percentile among these children (Adams, Quinn & Prince, p. 146, 2005)’’. This research study
was conducted among this diversity group measuring the obesity rate for these children.
Research from CDC within the following years 1988-1994 and 2007-2008 the prevalence of
obesity increased from 11.6% to 16.7% among non-Hispanic white boys, from 10.7% to 19.8%
among non-Hispanic black boys, from 14.1% to 26. % among Mexican-American boys, from 8.9% to
14.5% among non-Hispanic white girls, from 16.3% to 29.2% among non-Hispanic black girls and
from 13.4% to 17.4% among Mexican-American girls (CDC, 2010, par 6 & 7)”. Further research
should be conducted as to why the obesity rate has increased among boys and girls of diversity
populations than those who are not from diversity populations. However, this research did not give
any age ranges.
Societal and Environmental Factors affecting Childhood Obesity
In Wieting’s research there were factors that contribute to childhood obesity such as; “many
urban neighborhoods do not have supermarkets, outdoor produce stands, or other healthy alternatives
to convenience stores and fast food outlets, making it harder for residents to purchase fresh and
inexpensive produce (Weiting, 2008, par 10)”. Individuals need to consider planting a garden and,
fruit trees. This will offer an array of fruits and vegetables; also canning these tasty foods is a great
way for preparing to eat in the near future. By planting a garden, fruit trees, time and money will be
saved in the future. Have the children to engage in planting the garden, fruit trees and especially in
harvest time to see how their hard efforts has produced such tasty, healthy and colorful foods.
Relation of Previous Research
Previous research has shown that over the past two decades children’s diets have increased in
high-calorie, low-nutrition foods and sugar beverages. In the early 1990s public schools began
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offering snack foods and high calorie foods as an option to purchase (Gleamson & Suitor, 2001).
Vending machines often placed on numerous campuses that were stocked with high processed sugars
and low nutritional valued foods. Schools are required to offer meals that include protein and
vitamins. Although, the meals meet standards the meals continue to have high amounts of saturated
fat, sodium and not enough fruits, vegetables and whole grains to support adequate nutritional value.
On the other hand, “school officials describe the issue of providing healthier meals a problem due to
funding and the budget crisis (Cole & Fox, 2008)”.
According to Newman & Newman “obesity is related to activity level, for girls one of the
compounding factors in obesity is that they tend to reduce their activity level with age (Newman &
Newman, p. 323, 2009)”. By personal experience this appears to be true, when most girls grow older
they become less active where as in the past decades girls were expected by their parents to do their
chores inside and outside the home. In today’s society some girls may find that chores are some type
of child labor and question why do they have to do these chores or simply refuse to do them.
Through the past two decades it is obvious to see that trends in childhood obesity has spiked.
Through past and present research has indicated an increase in childhood obesity. For instance here is
a list of ages and the years that children with obesity as arose: “results from the 2007-2008 National
Health and Nutritional Examination Survey (NHANES), using heights and weights, indicate that an
estimated 16.9% of children and adolescents aged 2-19 years are obese, between 1976-1980 and
1999-2000, the prevalence of obesity increased, between 1999-2000 and 2007-2008, there was no
significant trend in obesity prevalence for any age group, among preschool children aged 2-5, obesity
increased from 5.0% to 10.4% between 197-1980 and 2007-2008 and from 6.5% to 19.6% among
those aged 6-11, among adolescents aged 12-19, obesity increased from 5.0% to 18.1% during the
same period ( CDC.gov, 2010,para 1)”. There is minimal research on school lunches. School lunches
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have not been associated with a contributing factor until recently. Most children eat most of their
meals at school during the week. Further research is needed to analyze the cause and effects of student
lunches on childhood obesity.
Theory Related to the Topic of the Study
The social learning theory developed by Albert Bandura explains that “human behavior is set
by cognitive factors, behaviors, and environmental influences (Social Learning Theory, 1977)”. The
social learning theory in this study will be used to examine if the high calories and fat intake of school
lunches and the inactive physical lifestyles of children contribute to childhood obesity.
Purpose of the Study Reiterated
The research study investigates a hypothetical cause of childhood obesity. School lunches are
given to children five days a week. Researchers suggest that students who pack lunch from home are
less likely to become obese. The study incorporates students from various ethnic backgrounds,
socioeconomic status, and gender.
Hypothesis
The hypothesis was derived from numerous Journal articles and books that suggest childhood
obesity is growing at an alarming rate. A number of researchers believe that there are various causes
that lead to childhood obesity. One cause that needs further investigation is if school lunches
contribute to childhood obesity. The hypothesis states, “Will students who eat school lunch more
likely to become obese”. As discussed earlier unhealthy diet and lack of healthy foods is a large
contributor to childhood obesity. In some cases, children will consume their breakfast and lunch at
school.
Even more unfortunate, school lunch may be the only or main meal some children may receive
during that day. Most school meals consist of a choice of meat, vegetable, starch, beverage, and
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desert. Then you have to also factor in the snack machines, snack carts, or fast-food lines that many
schools have that mainly serve fatty foods such as: pizza, French fries, burgers, sugary beverages, and
desserts.
Children are often limited with their choices and in most cases do not get all the nutritional
choices they may need. So, it is up to the school administration and dietary committees to make sure
the school is providing foods that are nutritious as well as tasty to the students. The reader has to keep
in mind, that this alone will not cause obesity, but can be a contributing factor. I plan to look at the
changes that need or may already be in progress to help students receive their necessary nutrition
Research Method
The method chosen for this research study is Quantitative. The quantitative approach for this
research study is that in childhood obesity Body Mass Index (BMI) is used to calculate obesity. Using
the BMI system, data will be obtained to collect numerical data to perform an accurate study.
Therefore, the quantitative method will be the appropriate data collecting process.
Methods Section
Introduction
Quantitative research is the method for this research study. Quantitative research uses a
method to compare the relationship between the Independent variable which in this case is the
school lunches. The Dependent variable is the Body Mass Index (BMI) of school age children who
eat school lunch will be compared to the Body Mass Index of school age children who eat lunch
prepared at home. Quantitative research focuses on a population. Therefore, the population in this
research study will be school age children who eat lunch at school and the other population will be
school age children who bring their lunch from home.
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Quantitative Research Method
According to Royse “quantitative tradition are large-scale effort, that attempt to characterize a
population group in a definitive way, these studies aim to provide precise information and report data
largely in terms of percentages and proportions (Royse, p.27, 2011)”. This research study will give
various percentages of childhood obesity stats among race and gender (ex. 100 participants are
randomly chosen, among the 100 only 79 will be chosen. The quantitative method approach was used
in this research study to evaluate the population group which is children who eat school lunches. The
BMI will be the quantitative data used to compare the BMI of those who eat lunch at school and those
who eat lunch brought from home.
Quasi-Experimental Research Design
Because there is so many factors that contribute to childhood obesity the research proposal
design for this paper is Quasi-experimental. The Quasi-experimental designs are “those that fall a
little short of the ideal, it is not acceptable or possible to randomly assign clients to one of several
treatment modalities or to a control group receiving no intervention (Royse, p.121, 2011)”. There are
various types of quasi-experimental designs, but the one chosen for this research study is called timeseries or interrupted series. According to Royse “the time-series design is an extension of the onegroup pretest-posttest design, where a series of measurements are taken before and after an
intervention (Royse, p.123, 2011)”. For this research study it would be best to have a pretest-posttest
among obese children.
One example for the time series design within this research study would be to weigh the
children who are obese and, then wait some time later (1 month) then weigh the children again. By
doing so, this design would determine if any of the children had lost weight. This design may be used
continually to determine the outcome of weight loss, weight gain, and to access knowledge as to what
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other procedures need to be taken. The time series design will allow the researcher to “understand
trends and patterns in the data before the intervention is applied and then provides for continued
monitoring for major changes (Royse, p.123, 2011)”. Therefore, time series design is best for this
research proposal study to obtain a better prevention/intervention program.
Research Question and Hypothesis
The research question for this research study is: What is the relationship between Body Mass
Index and school lunches? The research question was developed based on research that the majority
of children eat school lunches twice a day plus a snack. The hypothesis is students who eat lunch at
school have a higher Body Mass Index compared to students who eat lunch prepared at home.
Definition of Terms
Within this research study are terms that need to be clarified by the use of definitions. By
using and defining definitions will produce more insight as to what this proposal is in relation to. The
following definitions for this proposal are:
Anorexia nervosa- ‘‘is an intense fear of gaining weight or becoming fat (Diagnostic and Statistical
Manual Disorders, Fourth Edition (DSMIV)”.
Body Dysmorphic Disorder – (BDD) ‘’an intense preoccupation with an imagined or slight defect in
one’s appearance (Child Study Center, 2002, para. 8)”.
Body Mass Index (BMI) - “Body Mass Index (BMI) is used to measure childhood obesity by
comparing weight to height. The BMI is usually a good indicator, but is not a direct measurement of
body fat (Berkowitz, 2005)”. Also, “obesity is defined as a BMI at or above the 95th percentile for
children of the same age and sex (Center for Disease and Control, para.2, 2000)”.
Muscle Dysmorphia- “Muscle Dysmorphia involves a preoccupation with the idea that one’s body is
not sufficiently lean and muscular, reverse anorexia (Child Study Center, 2002, para.11)”.
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Obesity- “The Centers for Disease Control and Prevention (CDC, para. 2, 2000) describes children a
Body Mass index in the 95th percentile and higher as obese with the same age and sex’’.
Demographic Characteristics of Subjects
One hundred children who were typically developing identified as obese according to their
Body Mass Index (BMI) were randomly selected as participants for the study. A local pediatrician
office in a rural town was the setting for the study. The participants were from different gender and,
their ages ranged from 5 – 12 years old. The participants were from various ethnical and
socioeconomic backgrounds.
Sampling Procedures
The Sampling Method chosen for this study is Simple Random Sampling. According to Royse
“a sample is a subset of that population; simple random sampling design is where each sampling unit
in the population has the same probability (an equal chance) of being chosen (Royse, p. 193 & 195,
2011,)”. This research proposal study will test the hypothesis concerning the contributing factors that
may cause childhood obesity. The researcher must gather a certain amount of volunteers to
participate in this research proposal study. The Simple Random Method will consist of 100
participants who are obese. All the participants have an equal chance to be chosen for this research
proposal study. A sampling frame will be used to obtain a certain number amount of the population
that will be used in this research proposal study for Childhood Obesity. According to Royse “a
sampling frame is a starting place to randomly select a sample of participants (Royse, p. 195, 2011)”.
Participants for this research study will be chosen from a school roster. Then a sampling
frame will be used. The sampling frame will consist of 79 (0.05) participants that will be randomly
chosen. The seventy nine participants chosen will represent a sample out of the 100 participants. A
sample is “a group of people (or objects, etc.) chosen to represent some larger group of people (or
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objects, etc.)” (Yedigis & Weinbach, 2009, p.195). The participants must be children who are obese to
continue the research study.
Data Collection Measures and Process
The researcher will obtain permission from the Institutional Review Board (IRB) requesting a
waiver of informed consent which will be applied into this research study in Appendix A. The
researcher will contact the director of Childhood Obesity Research associated with the CDC
requesting authorization for the 100 participants in the research proposal study (Research Participation
Request will be applied to Appendix B). Also, the researcher will obtain permission from the local
Health Department, Pediatrician office and the Board of Education to perform the research study.
The researcher will then use an instrument to measure uncontrollable eating habits and another
instrument to measure dieting behavior. The researcher will use two different instruments to obtain
the needed research for this study. The first instrument used will be Compulsive Eating Scale (CES);
the second instrument used is Concern over Weight and Dieting Scale (COWD) (Fisher & Corcoran,
2007). Each instrument will consist of a certain amount of questions that the participants will answer.
The instruments used will be “rated on a 5- point scale having different categories for various items;
the letters used in the rating are converted to numbers as follows: a=1, b=2, c=3, d=4 and e=5 (Fisher
& Corcoran, 2007). By doing this application it will check the reliability and the validity of the scores
being measured. There will be a copy of these instruments applied to the Appendix.
Also, the researcher will present a letter of participation within this research study.
Parents will then receive a letter from the researcher explaining the purpose for the research
study. The parents will have to sign an informed consent form and, the form must be on file before
the researcher may collect any data. The researcher will take the BMI of 79 randomly selected
students from the previous 100 participants. Therefore, the children will be categorized into two
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groups. The first group will be children who eat school lunches. The second group will be children
who bring school lunches from home. The BMI’s of the children will be calculated and compared.
Finally, the data will be analyzed and interpreted.
Finally, after the data is analyzed and interpreted the researcher will conduct programs for
prevention and intervention measures to help fight against Childhood Obesity. The goal will be to
make the participant’s feel that they can achieve controlling their eating habits, exercise and have a
sense of pride within their -selves. Most important the participants will be living healthier life- styles.
Settings and Locations
The research study will be conducted in a small rural town in the southeastern part of the
United States. Among the group of individuals were various ethnic and socioeconomic back-grounds.
The researcher for this study will gather information from various places such as: the local Health
Department, Pediatrician office, and School Cafeteria. All information gathered will be observed
carefully before being used. Being that this area is rural the settings mentioned previously will be
within the local vicinities. Therefore, the local settings and locations will be convenient for the
participants. Any participants that do not have adequate transportation, transportation will be
provided.
Ethical Considerations
It is vital to keep confidentiality among the researcher and the participants. There is so much
important information about the participants that should be kept confidential such as birth dates,
names, health status, residence etc. Within this research study all participants are volunteers; they are
free from harm and, may withdraw from the study whenever they like. All participants will be treated
with fairness and equal justice no matter their social, ethical and economical background. All
participants may be anonymous and, when using data about the participant’s different codes will be
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used to identify them instead of their names. Only the participants are allowed to share their
information if they wish. An Informed Consent will be presented to all participants and, participants
who are under age or who are incompetent must have their care giver to give permission.
Limitations of the Study
There are some limitations to the study. Most of the children received school lunches; there
were only a few children who brought their lunch from home. This made the research study difficult.
Many of the participants’ caregivers did not take into consideration that they were obese and, were at
risk for developing serious health problems. Another problem that was encountered was 79
participants was not an equal number for the research proposal study, so another participant was
chosen to make the study more accurate.
Due to the different age range and gender the obesity rate among the children varied.
However, an accurate result was hard to determine and, the research proposal study had to be
modified. After a year into the study and the use of BMI the participant’s results were similar. Most
of the participants were not interested in the research study so, incentives were offered. The
incentives offered were free health screenings for the participants. Therefore, the participation goal
was met.
Summary
The purpose for this research study was to find ways to alleviate Childhood Obesity which has
become a rampant growing epidemic. As stated throughout the research study Childhood Obesity has
been associated with various factors. The factors discussed throughout the research study include but
are not limited to: Race, Gender, Socioeconomic Status, and Environmental influences. Researchers
have linked the above factors to contributing to the cause of Childhood Obesity. Although, these are
factors related to Childhood Obesity research has proven that prevention programs are the key.
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Prevention programs that include an active lifestyle and healthy nutritional food selections as well as
intervention programs that encourage healthier eating and regular exercise should be incorporated in
all homes, schools and communities for longer healthier lives.
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References
Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, Office of Research,
Nutrition and Analysis; 2008
Bandura, A. (1977) Social Learning Theory. New York: General Learning Press.
Centers for Disease Control and Prevention, National Center for Health Statistics.
Charts: United States. US Department of Health and Human Services, Centers for 2010.
Accessed January 20, 2011. Disease Control and Prevention Web site.
http://www.cdc.gov/growthcharts.
Cole N, Fox MK. Diet Quality of American School-Age Children by School Lunch
Participation Status: Data from the National Health and Nutrition Examination Survey,
1999-2004.
Fisher, J., & Corcoran, K. (2007). Measures for Clinical Practice and Research: A Source Book.
New York, New York: Oxford University Press.
Elliott (2005). “Weighing Health: The Moral Burden of Obesity.” Social Semiotics 15
(2)113-115.
Gleason PM, Suitor C. Children’s Diets in the Mid-1990s: Dietary Intake and Its Relationship
with School Meal Participation. Alexandria, VA: US Department of Agriculture, Food and
Nutrition Service; 2001.
Haskins R. The school lunch lobby. Education Next. 2005; 5:11–17
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Miller J, Rosenblum A, and Silverstein J. “Childhood Obesity”. The Journal of Clinical
Endocrinology & Metabolism. 2004. 89(9):4211–4218.National Health and Nutrition
Examination Survey. 2000 CDC Growth.
Newman & Newman, (2009): Development through life: A psychosocial approach. Belmont, CA (10th
Ed.) Cengage Learning
Robert Wood Johnson Foundation, American Heart Association. A Nation at Risk:
the
United States. A Statistical Sourcebook. Robert Wood Johnson
site.
http://www.rwjf.org. Robert Wood Johnson Foundation;
2005.
Obesity
in
Foundation
Web
Accessed
April
2008.
Schanzenbach DW. Do School Lunches Contribute to Childhood Obesity? In: Chicago,
IL:
Harris School Working Paper; October 2005; p. 5–13
Weinshenker, N (2002) Nutritional quality of the diets of US public school children
and
the
role of the school meal programs. Child Study Center. 2002; 109 (suppl 1): S44–S56
Yegidis, B.L., & Weinbach, R.W. (2009). Research methods for social workers. Boston, MA:
Pearson Education, Inc.
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Appendix A: Consent to Participate in a Research Study
Consent to Participate in a Research Study:
Children Participants
Social Behavioral Form Example
IRB Study #1971Consent Form Version Date: 04-14-2011
Title of Study: Childhood Obesity
Principal Investigator Contact Information: 919-333-4566
What are some general things you should know about this research?
You are being asked to take part in a research study because there is a need to identify children
who are obese, and to seek prevention/intervention programs.
To join the study is voluntary.
This research study is to help children who are obese and give them opportunities to engage in
health programs. There will be a pretest and posttest within this study and the research will be
conducted for 6 months.
What are the risks or costs associated with participation?
There are no anticipated risks associated with your participation in this survey. There are
also no costs involved in this study.
What are the benefits associated with participation?
Participants in the research study will receive free health screenings.
However, your participation will benefit students in the university setting as
the results may be used to improve their educational experience.
How will your privacy be protected?
Participants will not be identified in any report or publication related to this study and no
identifying information will be collected.
What if you have questions about this study?
You have the right to ask, and have answered, any questions you may have about this
research. If you have questions or concerns, you should contact the researchers listed at
the top of this form.
What if you have questions about your rights as a research participant?
All research on human volunteers is reviewed by a committee that works to protect your
rights and welfare. If you have questions or concerns about your rights as a research
subject you may contact, anonymously if you wish, the chair of the Institutional Review
Board (Dr. Timothy Hayes) at 910.522.5785 or by email to irb@uncp.edu.
Participant’s Agreement:
I have read the information provided above. I have asked all the questions I have at this
time. I voluntarily agree to participate in this research study.
Use the blanks below ONLY if you are required to have written/signed consent.
Sharon M. Cummings
04-14-2011
Signature of Research Participant Date
Mary S. Jones
04-14-2011
Printed Name of Research Participant
Use the blanks below ONLY if you are obtaining consent in person.
_________________________________________ _________________
Signature of Person Obtaining Consent Date_________________________________________
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Appendix B: Student Participation Letter
Initial Student Participation Letter:
Greetings,
In order to gain a research study through the use of qualitative methods, I am seeking
participants who are children that are obese. A purpose of this study is to gain knowledge about
children who are obese and the risks that occur to this cause. There will be a sample of 100
participants of different races to explore various factors that contribute to Childhood Obesity. The
outcome of this research study may contribute to knowledge of the affective process of obesity as
eating habits, lack of exercise and school lunches.
You were selected as possible participants in this research study to gain insight into what
programs are needed to help children living with obesity. There will be a survey for participants to fill
out to get a basic baseline as to where interventions may be needed (this is only a study).
If any questions either now or after completing the research study please feel free to contact me at:
Sharon M. Cummings (UNC-Pembroke), (919-333-4566) or e-mail at src015@bravemail.uncp.edu.
Thank you in advance for participating in this research study!
Sharon M. Cummings
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