Rising Childhood Obesity: A Global Concern

Chapter 1: Introduction

1.0 Introduction

Childhood obesity is one of the major health concern faced by children in the current era. This is evident as in the UK it is predicted that by 2030 there would be nearly 1.3 million children with obesity in the population (NHS England, 2020). Moreover, globally it is forecasted that by 2030 nearly 250 million children will be obese which is currently in 2019 is 150 million (Boseley, 2019). The increased childhood obesity is a major concern as it is leading the children develops additional health issues such as sleep apnoea, diabetes, heart problems and others. The key cause behind the rising rates of childhood obesity is found to be having unhealthy foods and leading sedentary life (Ward et al., 2017). Thus in this study, the impact of diet and lifestyle changes of the children suffering from obesity is to be discussed so that actions can be determined to prevent the progressing prevalence of the medical concern.

1.1 Background of the Study

Childhood obesity is a medical health issue which leads children to develop excessive storage of body fat that contributes to raise their overall body weight in an uncontrolled manner with high BMI rate (Rao et al., 2016). The risk associated with the presence of childhood obesity among children is increased blood pressure and high cholesterol that makes them prone to develop early cardiovascular disease. The other risks include the development of glucose intolerance or insulin resistance out of excessive body fats that conceal the tissues to absorb insulin from the blood making the children prone to develop early type-2 diabetes (Hemmingsson, 2018). The risk of childhood obesity is mainly dependent on the diet and lifestyle choices of children. This is because children who are involved in having excessive fats foods and less amount of healthy food are prone to develop obesity at an early stage. Moreover, increased sedentary activity with less physical activity such as walking, running, playing and others lead children to develop obesity as their body is unable to use the stored calories to be shed in the form of energy, in turn, raising their obesity (Bush et al., 2017). Thus, focus on the impact of diet and lifestyle changes for children suffering from obesity is to be made. This is because it would help to gather information from existing literatures about the particular changes in existing diet and lifestyle for the children is to be made for preventing or avoiding obesity.

1.2 Significance of the Study

The present research is significant because it may contribute to the way diet and lifestyle of the children are to be managed so that they can be prevented to suffer from obesity. The information to be presented in the study is significant to be used by the parents and families in determining the way current lifestyle and diet of their children are influencing their children’s health and the way it could be changed with making alteration in eating and lifestyle. Moreover, the findings in the study could be used by the researcher to use it as a basis to make different perspective in future for a similar topic.

1.3 Rationale

In Europe, one of the highest numbers of childhood obesity is found in the United Kingdom (UK) (Siddique, 2017). According to National Child Measurement Programme, 1 out of 10 children living in the UK who belong to reception age (4-5years) and 1 out of 5 children who belong to 10-11 years of age living in the UK are seen to suffer from obesity as per reports received in 2018 (BUPA, 2018). Therefore, discussion regarding childhood obesity is important as it is one of the prevalent health issues being faced in the modern era. The high obesity rate among the children in the age group is mainly due to their inappropriate dietary intake and lower physical activity (Karachaliou et al., 2020). In 2018, it was identified that 62% of the school-going children who are mainly 5-16 years of age in the high-income countries such as the UK involve in drinking carbonated high-sugary drinks and nearly 49% of them involve in eating fast food that is high in calorific value with fewer nutrients in a week (UNICEF, 2018). In a report by UNICEF, it is mentioned that children in the UK who belong to 5-11 years of age each week lose 63 minutes of exercise and active lifestyle out of their sedentary activities (UNICEF, 2018). Thus, hindered diet and lifestyle activity is seen to be maintained by most of the children which may be leading them to develop obesity. The intake of the increased amount of carbonated high-sugary drinks is a contributor for childhood obesity because such drinks are responsible for providing high calories to the body with limited nutritional benefits. It leads the children to remain hungry as, without adequate nutrients in the body, the body fails to function in creating energy to resolve hunger. The existing hunger feeling leads the children to take in more food and overeat leading them to add extra weight in their body and drastically raise the BMI rate resulting in obesity (Lee et al., 2018). As criticised by Navti et al. (2017), sedentary lifestyle activity in childhood obesity has become an issue. This is because it leads the children to spend increased time in sitting and watching television, playing video games instead of involving in physical activity or exercise. The physical activity in children is important for their growth as well as avoiding input of extra weight. This is because exercise leads the body to use stored fats in generating energy leading to help the children shed body weight (Karachaliou et al., 2020). As commented by ielgo-Ayuso et al. (2017), fast foods are considered as one of the key issues in promoting childhood obesity. This is because such foods are high in fats and carbohydrates that get deposited in the body to increase the weight with less presence of vitamins and nutrients in the fast foods the body do not have adequate opportunity to be provided nutrition to the body. It leads to increased intake of calories by the children that add to their body weight to make them become obese (Mielgo-Ayuso et al., 2017). The issues of diet and lifestyle regarding children in childhood obesity have currently become an issue. This is because increased intake of an unbalanced diet and unhealthy lifestyle has led 20.4% of children of 10-11 years age to be regarded as obese in 2018 which was 13.7% in 2013 (NHS England, 2020). This indicates that the diet and hindered lifestyle activity of the children have led to worsen the childhood obesity image in high-income countries such as the UK. Moreover, these rising numbers of childhood obesity are seen in the UK irrespective of initiatives such as the initiative to implement sugar tax (tax on drinks with high sugar content), executing health promotion programs such as Start4Life and others (Thornton, 2018; NHS, 2017). Therefore, it is essential to discuss the impact of diet and lifestyle changes for children suffering from obesity in different countries so that it could help children in the UK in overcoming the prevailing increase in childhood obesity rates. Thus, in this study, the impact of diet and lifestyle changes for children suffering from obesity in different countries is to be discussed.

1.4 Aim

The aim of the study is to identify the impact of lifestyle changes on children suffering from obesity.

Chapter 2: Literature Review

2.0 Introduction

The current chapter has the focus to critically examine and analyse the effect of diet and lifestyle change in relation to children suffering from obesity. In this purpose, concepts regarding diet and lifestyle along with childhood obesity are to be explained to provide an overview regarding the terms. The models and theories related with the variables are to be discussed to create a logical understanding of diet and lifestyle changes along with childhood obesity. Thus, the review of the current literature is going to create an effective understanding of the topic.

2.1 Concept of diet and lifestyle

Diet is referred to the course of food usually eaten by a personal to meet hunger and avail nutrients required in the body functioning (Brady, 2017). However, lifestyle is the way of living of a person that shows their opinions and beliefs in society (Grigorakis et al., 2016). The diet and lifestyle are inter-related because based on the way a person chose to live directly influences their choice of food. For instance, people maintaining an urban lifestyle where the people have lack of time to cook are often seen to resort to accessing fast food and carbonated drinks. This is because such foods are easily available as well as tasting great which makes individuals living an urban lifestyle crave such food (Brady, 2017). In urban lifestyle, children are often seen to be involved in watching television and playing video games making them maintain a sedentary lifestyle without involvement in active physical exercise (Kracht et al., 2020).

2.2 Factors affecting diet and lifestyle in children

The parental influence is a major factor that influences diet and lifestyle of children. This is because in the childhood stage the children are unable to analyse and determine the nature of food and activities which are right for their healthy living. The parents take decisions on the behalf of the children who influences them to eat and live proper lifestyle suitable to the society (Yannakoulia et al., 2016). As argued by Stea et al. (2016), family environment influences the diet and lifestyle of the children. This is because children during their early years are found to be close to the family who influence their decision regarding the way to live their lifestyle and have foods. In the study by Yannakoulia et al. (2016), presence education levels among the parents is one of the key factors that influence diet and lifestyle of the children. This is because if the parents have poor education they are unable to determine which foods are healthy making the children eat improper food which may create issues towards their health.

2.3 Models of diet and lifestyle management

2.3.1 Healthy Eating Pyramid

The Healthy Eating Pyramid informs about the nature of food to be included in the diet to promote healthy eating. This is evident as pyramid mentions intake of vegetables, whole grain, fruits, healthy proteins and oils along with little yoghurt or milk is to be included each week in the meal (Feldman et al., 2018). The pyramid framework also mentions minimizing intake of salt and sugar along with indicating that the packaged foods and drinks are to be avoided to remain healthy. According to the pyramid, effective weight control and daily exercise are to be executed by individuals as a part of healthy living (Feldman et al., 2018). Thus, following the Health Eating Pyramid would help to determine the nature of healthy foods is to be included in the changed diet and lifestyle of the children who are suffering from obesity to resolve their health condition. This is because it asks to avoid intake of fast foods that is one of the main contributors of creating risk of obesity along with specifically mentioning the key healthy foods to be taken to promote healthy living.

2.3.2 Socio-ecological Model of physical activity

According to Socio-ecological Model of physical activity, social and physical environment that include friends, family, neighbours, formal and informal organisation and others are responsible in influencing physical activity among children (Wingate et al., 2018). Thus, the social and ecological factors are to be considered in promoting physical activity among people. It is evident as children who have friends those are involved in active playing are seen to involve in executing physical activity by physically playing with them on the grounds (Wingate et al., 2018). However, children with friends who are involved in playing video games and watching television are seen to lead a sedentary lifestyle with no effective physical activity. This is because they do have company to physically play (Essiet et al., 2017). Thus, it can be considered that social and ecological environment among children are responsible to make them develop less activity and involve in sedentary actions which eventually contributes to their risk of obesity. This is because the fats and nutrients get stored in the body which are unable to get converted into energy leading the children gain body weight (Fernandes et al., 2019).

2.4 Theories of diet and lifestyle management

2.4.1 90/10 Theory

The 90/10 Theory mentions that to lead a healthy life people are to follow healthy meal plan for 90% of the time while the rest 10% of the time the people can involve in eating unhealthy meals such as fast foods, sugary drinks and others (modernsoapmaking.com, 2020). This theory could be used in managing diet changes in children with obesity where 90% of the time they would be involved in healthy eating while rest 10% of the time they can involve in taking fast foods and others. It would be effective as the children can be involved in eating healthy without totally barring them from eating fast foods and sugary foods which they crave and wish in their life.

2.4.2 Health Lifestyle Theory

The Health Lifestyle Theory mentions that healthy lifestyle choices among individuals are not connected with the random preferences of the individuals but are clustered in distinct patterns which are based on class, social customs, gender and others (Saint Onge and Krueger, 2017). It is evident as in 2018, it is reported that 4 million children in the UK who are living in poor household are struggling to afford vegetables and health foods and are involved in eating fast foods and drinks. This is because people in the UK who belong from the lower classes consider eating fast foods and sugary drinks as cheap compared to healthy vegetables (Boseley, 2019). However, people from the high class are seen to eat more healthy foods as they can afford the items within their financial status (Patrick, 2018). Thus, it can be considered that rising prevalence of childhood obesity as a result of unhealthy diet could be due to the differences in the availability of finances among social class to avail healthy foods.

2.5 Concept of Childhood Obesity

Childhood obesity is regarded as serious medical issue that leads children to develop weight above normal due to deposition of fats in the body. The symptoms of childhood obesity include breathing disorder, high blood pressure, sleep apnoea and others (Nanney et al., 2017). The obese children develop breathing disorder because increases deposition of body fat within the body causes mechanical compression o the chest cavity and lungs that bars the individual to normally release enough amount of carbon dioxide and inhale adequate oxygen to maintain normal breathing (Nanney et al., 2017). In the study by Frye et al. (2019), it is argued that obese children develop increased amount of fat in the upper respiratory tract which causes narrowing of the airways and decrease in muscle activity in the area. This leads the children to develop apneic and hypoxic episodes during sleep making them to develop sleep apnoea.

2.6 Factors influencing childhood obesity

The intake of high-calorie foods liked snacks, fast foods, vending machine foods and others contributes to influence childhood obesity. The increased eating of sugary drinks also influences rise of childhood obesity (Kenney and Gortmaker, 2017). This is because these foods out of high calorific value and low in nutrients make the body unable to act optimally to produce energy, in turn, influencing overeating to avail more nutrients which contributes to rise in weight (Kenney and Gortmaker, 2017). The lack of physical exercise leads to increased weight gain as it does not creates opportunity for the body to burn stored calories and fats (Sirico et al., 2018). The psychological condition of the children also influences them to be obese. This is because children who are depressed and stressed are found to involve in overeating to resolve anxiety and stress making them intake more calories than normal which raises their overall body weight (Rankin et al., 2016).

2.7 Model of childhood obesity management

2.7.1 Health Belief Model

The Health Belief Model is referred to as a social and psychological frame that supports change in health behaviour among individuals. According to the model, through perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy and modifying variables behaviour change can be influenced among individuals (Abdeyazdan et al., 2017). The model is able to be used in making diet and lifestyle changes in the children suffering from obesity. This is because through perceived susceptibility the children and their parents would understand the risk related with the current health condition and need for change. The perceived severity would educate the children and their guardians about the severity of the health issues and consequences to be faced without making change in their current behaviour. The perceived benefits would help the children develop knowledge regarding the advantage of making the behaviour change being asked regarding diet and lifestyle for their obese condition, in turn, making them feel positive to make the change out of the determined benefits. In addition, cues to action and self-efficacy promoted through the model would lead the children and their parents feel motivated and self-sufficient in making the change for diet and lifestyle which is important in coping obesity.

2.7.2 Beveridge Model

The Beveridge model mentions that the government is to provide healthcare to all the citizens through the use of finances availed by the government from income tax payments (Moisidou, 2017). The model is already been followed in the UK where healthcare is provided to all by the government in the country. However, the support for diet and lifestyle changes is not included in the model. Thus, it indicates that the government in countries following the model such as in the UK are unable to provide support to individuals in making behaviour change. This in turn can be considered to have led creating hindered diet and lifestyle changes in the countries promoting childhood obesity as the required support for healthy diet and behaviour change is not provided by the government.

2.8 Theories of childhood obesity management

2.8.1 Theory of Planned behaviour

The Theory of Planned Behaviour (TPB) informs that likelihood of individuals to execute certain health behaviour is correlated with their strength of intension in making the particular behaviour (Mazloomy-Mahmoodabad et al., 2017). Thus, it indicates that to make diet and lifestyle changes among children suffering from obesity, their personal intension to make the change is to be promoted. This is because it would make them self-inspired in altering their current hindered diet and lifestyle which is contributing to worsening the effect of obesity on them. According to the theory, the behaviour change is also influenced by the beliefs and attitude of the people (Schuster et al., 2016). This indicates that change in diet and lifestyle among the children with obesity can be achieved to promote its effect on the children when the children, as well as their guardians, develop the belief and attitude that the change is going to create immense health benefit.

2.8.2 Social Cognitive Theory

The Social Cognitive Theory mentions that learning to make any change occurs through self-observation, self-evaluation, self-efficacy and self-reaction. This indicates that people are indented to make change when they personally observe and evaluate the benefits of the change and personally react to the impact of the change through self-efficacy (Zacarías et al., 2019). According to the model, to make diet and lifestyle change among children suffering from obesity they are to be influenced to personally observe and evaluate the importance of the mentioned change. This is because it would make them understand the value of them which would intend them to personally react to execute the change. However, effective resources are to be made available to the children in making the change so that they feel self-efficacy in making the diet and lifestyle alteration required for obesity management.

2.9 Nature of healthy diet and physical activity that affects management of childhood obesity

In the study by Koo et al. (2018), it is mentioned that intake of whole grains as dietary intake is associated with lowering the risk of childhood obesity along with its management in affected individuals. This is evident as 12% weight different, 2.6% lower body fat percentage and 2.4cm waist circumference is seen among children in the study who were under whole grain dietary intake. Thus, it indicates that whole grain can be included in the changed diet of the children with obesity in acting to lower their body weight. In contrast, the study by Nour et al. (2018) mentioned that intake of fresh vegetables are effective dietary intake for people suffering from obesity as it contributes to loss of weight. This is evident as 0.09-1 kg reduction in weight over the past four years along with reduction of chances of overweight or obesity is found among the study participants in the research who were involved in taking vegetables as dietary intake. In the study by Marson et al. (2016), it is mentioned that execution of aerobic exercise is an effective intervention of changed lifestyle for children suffering from obesity. The aerobic exercise includes running, cycling, walking, swimming and others. It involves making the body use stored fats and lower body weight. In study institution, the inclusion of compulsory physical activity is found to be effective in making children change their sedentary lifestyle which is contributing to make them obese. This is because such opportunity makes the children feel boosted to make change in their sedentary actions, in turn, helping them avoid storing extra fats in the body which increases their weight (An et al. 2017).

2.10 Gaps in Literature

The existing literature provides adequate information regarding the study topic but gaps are present in explaining the impact of diet and lifestyle change among children suffering from obesity. In the existing studies, there is lack of information regarding the way dietary changes and lifestyle changes are contributing to lower body weight of children with obesity. Moreover, the literature does not clearly inform about the barriers to be faced in achieving the impact of the change or making the changes by the children with obesity. Therefore, to resolve the gaps in the study further analysis of the topic is to be executed.

2.11 Summary

The existing literature review based on the topic informs overview of the diet and lifestyle influencing obesity among children. It has also led to provide insight into the theoretical framework and model that could be used in making changes in dietary intake and lifestyle among children suffering from obesity. Moreover, the chapter explains about the nature of dietary and lifestyle changes are to be executed by the children to have positive effect on managing obesity.

Chapter 3: Methodology

3.0 Introduction

In this chapter, the detailed methods and systems to be used in executing the study is to be discussed. This is because it helps to create a pathway suitable according to the study to be followed in gathering enhanced result and findings to resolve the raised queries and meet the research objectives.

3.1 Research Design

The narrative literature review is the critical, comprehensive and objective analysis of existing knowledge regarding a study topic. The key purpose of narrative literature review is that it helps to identify similar studies regarding the topic of interest to gather required information in resolving the raised question in the study (Schwebel and Larimer, 2018). The benefit of narrative review is that it provides opportunity for the researcher to present a general overview regarding the topic to provide primary information. Moreover, it is easier to be executed as no specific complex protocols are to be followed as seen in systematic reviews (Byrne, 2016). The meta-analysis review is not used in executing the study. This is because the current study is heterogeneous and hard to be comparable which would lead to present meaningless and biased facts in the study (Rees et al., 2016). Thus, narrative literature is to be used in executing the study.

3.2 Research Question

The presence of a well-defined research question is important because it helps to guide the researcher in making decisions about the nature of the study design to be used and the nature of data to be collected and analysed in the study (Doody and Bailey, 2016). The PICO framework is one of the effective tools for developing research question because it helps to include key parts of the topic in framing the research question. Moreover, it also assists in formulating effective research strategy to be used in identifying key concepts to be included in the study (Considine et al., 2017). As argued by Eriksen, M.B. and Frandsen (2018), the lack of a well-focused question in the study leads to create difficulty in executing research. This is because the researchers are unable to determine in which direction and nature of data to be included in the study for its effective formulation. Further, the lack of a well-defined question leads the research waste increased amount of time and present hindered findings (Doody and Bailey, 2016). However, the use of PICO framework would provide effective direction to the researchers in the study about the specific concepts to be focussed in turn avoid confusion and increased time consumption in building the study. The PICO stands for population, intervention, comparison and outcome. The population indicates the key characteristics of the participants to be maintained in the study for its enhanced execution (Considine et al., 2017). In this study, the population of focus is children who are below 16 years of age and are suffering from obesity or are at risk of obesity. The intervention is the technique of focus in the research that is being considered to create a positive impact on the selected population (Considine et al., 2017). The intervention in this study is diet and lifestyle changes in relation to childhood obesity. The comparison refers to the alternative technique used in the study apart from the intervention. In this study, no alternative techniques are been considered for childhood obesity management. The outcome is the effect, improvement or accomplishment wished to be achieved by the researcher through the execution of the study (Considine et al., 2017). In this study, the outcome focussed is improved health and reducing of weight of the children suffering from obesity. Thus, on the basis of the factors, the research question is: What are the impacts of diet and lifestyle changes among children with obesity?

3.3 Search Strategy

The electronic search strategy is to be used in the study for deriving required information in accomplishing the research. The advantage of executing electronic search is that it provides faster and less time-consuming opportunity to the researchers in gathering data needed in the study. It also helps to execute the research in a cheaper way as it avoids reduction of cost needed to physically gather data by buying books and articles. The error margin in gathering data is also reduced in the electronic search strategy as keywords and letters could be used to directly derive the data required in the study. This nature of search also resolves the difficulty of geographic barriers that avoid gathering enhanced data (McGowan et al., 2016). The execution of electronic search strategy is to be done by using keywords in platforms such as CINHAL, MEDLINE, Goggle Scholar and others. The following platforms are to be used as they provide opportunity to the researchers in gathering evidence from pool of articles that are published worldwide. Thus, it leads to include data from overseas in the study to ensure its enriched execution. The keywords to be used in executing the study include “childhood obesity”, “obese children”, “lifestyle in childhood obesity”, “diet in childhood obesity”, “lifestyle intervention” and others. The Boolean operators are to be used in connecting the search terms so that effective research could be executed. The Boolean operators such as “AND” and “Or” are to be used in connecting the mentioned keywords in the research to formulate effective searching.

3.4 Inclusion and Exclusion criteria

The inclusion criteria are defined as the characteristics which are significant and important to the study to collect related information and data of the study topic. In contrast, the exclusion criteria are defined as the variables which are prevented from inclusion in the study as it would disrupt the flow of the research and create error in presentation of information in the research (Patino and Ferreira, 2018). In the current research, the inclusion characteristics are articles published on and after 2016, written in English Language, presented in detailed format, involve primary research, related to diet and lifestyle of children suffering from obesity and overweight and has academic format. The exclusion variables would include articles published before 2016, has secondary information, related to treatment aspects of childhood obesity, not written in English, partially available and non-academic presentation of information. The articles that are published on and after 2016 to 2020 are to be included in the study because they include scientifically updated data backed-by updated experimentations to provide unique and error-free along with advanced data. The articles before 2016 is not to be used because they contain backed research information that may have been currently considered invalid with modern experimentation. Thus, including such articles would hinder the validity and reliability of the study too by creating error. The articles in the English language only are to be used for gathering information in the research because the researchers involved in this study have only knowledge of English and not any other languages. Therefore, the articles written in languages other than English are to be avoided as the researchers cannot derive meaningful data from them due to lack of understanding or identification of the language. The articles in which the data are gathered through primary research are to be used in the study because it provided opportunity to the researcher in having confidence to know and understand information in an appropriate and untarnished manner. Moreover, the primary research articles provide opportunity to the researchers in gathering objective and statistical data along with direct descriptive interview transcripts of the participants to present information in an evidence-based and authenticated way. The articles which use secondary research such as a systematic review, meta-analysis and others are to be excluded in the study because they fail to provide authenticated information at times as the data presented in the studies are sometimes influenced by the biased thinking and perception of the researchers. Therefore, using such articles would lower the authenticity and reliability of the study. The study related to diet and lifestyle of the children with obesity and overweight is to be considered for inclusion in the study because it would help to draw relevant data required in meeting the raised question in the study. Moreover, the articles where treatment options available for childhood obesity are to be avoided from inclusion in the study as they do not have relevant data required in the current research. The articles which are academic are to be considered for inclusion in the study as the information in those articles is logically proved with enhanced scientific experiments and data. The articles written in non-academic manner and sources are to be excluded in the study so that unreliable and tarnished information is presented in the researcher which would disrupt the study validity and reliability in the end.

3.5 Sampling

On the basis of the inclusion and exclusion criteria, the sample in the study is to be selected. The sample mainly would be articles related to the current topic of discussion. In total, 18 articles are to be used in presenting the information required in resolving the raised question in the study.

3.6 Data Analysis

The data analysis is to be executed through the use of thematic analysis method. The key purpose of thematic analysis is focusing on the rich description of data under themes for their meaningful interpretation (Terry et al., 2017). The benefit of using thematic analysis is that the theoretical freedom in the analysis provides opportunity to the researcher to develop a flexible approach in modifying the needs of the study so that an enriched and detailed data can be presented. Moreover, it is appropriately suitable in presenting large data sets in a systematic manner under themes. It allows inductive creation of themes and data that go beyond individual experience (Braun and Clarke, 2019). Therefore, it is to be used in the study as it allows multiple theories and facts related to impact of diet and lifestyle change among children with obesity to be presented. In order to execute thematic analysis, initially the qualitative data to be presented in relation to the study is to be analysed. This is to closely evaluate the key actions and facts in the data to identify related themes to be presented in the study so that an effective pattern of data presentation is maintained. In this study, a total of 4 themes are to be developed in presenting the gathered data from the articles.

3.7 Ethical Consideration

The ethical consideration in research is essential to be followed so that any legal issues and violation of policies are not faced during the study which may have created unethical error in the study (Minaya, 2016). In order to maintain ethical concern in the study, the researcher is going to effectively reference the name of author and date of publication of the facts presented. This is because avoiding to effectively referencing one's work results in creating plagiarism issues. In the study, no personal information of any participants is to be used if available from any previous articles where effective ethical procedures are not maintained. This is to maintain confidentiality and privacy of the participants that may not have been followed by the previous researchers. However, if the ethical procedures are followed in the previous articles and still the personal information of the participants are shared, and then the information would be used. Moreover, personal attitudes and beliefs of the researchers are to be avoided in influencing the presentation of findings in the study.

3.8 Gantt Chart

A Gantt chart informs the way planning and scheduling of the entire research is been performed so that it can be accomplished within the provided deadline (Sharon and Dori, 2017). Thus, a Gantt Chart for the study is been developed to inform the way the study is scheduled and planned to be accomplished. (Refer to Appendix 2)

3.9 Summary

The above discussion informs that narrative literature review research design is to be used and the articles to be chosen for the review is to be identified by using electronic search by maintain inclusion and exclusion criteria.

Chapter 4: Results, Findings and Discussion

4.1 Results and Findings

4.1.1 Theme 1: Impact of diet for children suffering from obesity

The change in dietary pattern towards eating healthy food instead of fast food is seen to have an effective link with managing obesity and overweight issues among children. This is evident from the study of Suiraoka et al. (2017) where it is mentioned by the nutritionist that increased eating of fast food along with sugary drinks and unhealthy food items are leading children to become overweight and obese. Moreover, the study by Mekonnen et al. (2018) reported that fast food intake along with low intake of fruit and vegetables and increased sugary drinks are vulnerable risk for causing obesity among children and worsening their health. In relation to this, the study by Jones et al. (2020) informed that increased fruit and vegetable intake have positive effect on health outcomes of the young children with obesity or at risk of obesity. For this purpose, 243 Navajo children are surveyed in between May 2015 extending to September 2018. In the beginning of the intervention, it was seen that 60% of the participants in the study were obese and 40% were overweight. However, after the intervention of healthy eating that involved vegetables and fruits among the participants, the results revealed that only 38% were obese along with 38% reaching healthy BMI rate and only 24% remained slightly overweight. This indicates that healthy eating has an enhanced impact on reducing obesity or overweight among children. The study by Notario-Barandiaran et al. (2020) also informed that the impact of increased adherence to Mediterranean diet at the age of 4 years lowers obesity or overweight among children at the age of 8 years. The Mediterranean diet mainly includes eating of vegetables, nuts, beans, legumes, fish and others along with unsaturated fats. The results revealed that children who involved in taking Mediterranean diet at the age of 4 years expressed lower incidence of obesity ((Hazard ration (HR) = 0.16; 95% CI: 0.05–0.53; p = 0.002), overweight (HR = 0.38; 95% CI: 0.21–0.67; p = 0.001) and abdominal obesity (HR = 0.30; 95% CI: 0.12–0.73; p = 0.008) at the age of 8 years in the study. This indicates that eating healthy vegetables along with unsaturated fats at the early age has lasting impact on preventing children to experience obesity who due to avoiding the intake of such diet is currently suffering from the health issue. In addition, the study by Kim et al. (2017), a cross-sectional analysis is performed by collecting three-year data from Korea School Health Examination Survey to determine the impact of chicken consumption and red meat and its association with high blood pressure and obesity in children. In the study, it was revealed that children who were obese and consumed red meat more than five times a week compared to those who ate red meat once a week expressed lower obesity. The facts are proved in the study by indicating low or high blood pressure as the researchers mentioned that high blood pressure is related to subjects who are obese compared to individuals with no extra weight. In the study by El Amrousy and El-Afify (2020), the key idea was to determine the impact of alpha-lipoic acid as a supplement in food for obese children. The results revealed that obese children those received at least 300mg of alpha-lipoic acid as supplement through the foods expressed reduced body weight and lower body mass index (BMI). This is evident as the p-value for each of the factors was less than 0.05 indicating the results were statistically significant.

4.1.2 Theme 2: Impact of active lifestyle on children suffering from childhood obesity

The change towards including physical activity in everyday lifestyle among the children is seen to be actively linked with managing obesity in them. It can be seen from the study of Lu et al. (2018) where it is informed that school-based exercise program is effective in lowering the body fat and body mass among obese children. The is evident as the results revealed that inclusion of school-based exercise lead to 1% decrease in body mass and 1.9% decrease in body fat among 11 of the obese participants in the study. In the study by Coimbra et al. (2017), it is informed that physical exercise intervention in school is effective to lower BMI rate and body weight of obese children. This is evident because the results revealed that in each case out of the physical program each of the participants expressed lower weight (P=0.026), less BMI (P=0.040), reduced waist circumference (P=0.010) and others compared to be the control group. This indicates that change towards physical activity is directly linked with managing obesity among children. In the study by Desalew et al. (2017), it is mentioned that children suffer from obesity as a result of increased sedentary lifestyle. This is evident as the researchers reported that in the study the children who preferred not to engage in regular physical activity and maintain sedentary life during their free time by watching television and playing computer games were more significantly associated with showing overweight and obese condition. In relation to this, the study by Brasil et al. (2020), mentioned that involvement of obese children in judo as lifestyle activity is effective physical activity in lowering their BMI rate and fat mass in the body. This is evident as mean fat mass before the intervention among the participants was 22.8 kg which was lowered to 22.3 kg post-intervention. Moreover, the percentage of fat in the body reduced from 42.4% to 39.9% post-intervention along with mean BMI rate reduced from 2.22 to 2.17 post-intervention among the obese children. The study by Cvetković et al. (2018), compared the impact of recreation football with high-intensity interval training (HIIT) on muscular fitness, cardiovascular fitness and body composition of overweight and obese children. The results revealed that 4.3% body mass and 4.45 muscle mass increased among the obese participants in the recreation group compared to those in the HIIT group where 2.5% body and 2.8% muscle mass was seen to be increased. In the recreation football group, 7.7% body fat was reduced compared to 5.2% reduction of body fat among the HIIT group. This indicated that both the recreation football activity and the HIIT is effective in creating muscle improvement and fat reduction among the obese children but the initial activity is more effective compared to the later action of HIIT. In the study by Ham et al. (2016), the key aim was to determine the impact of transtheoretical model-based exercise counselling with music skipping rope exercise as lifestyle intervention for the obese children. For this purpose, 75 obese or overweight children are included in the study. The exercise counselling was provided for 8 weeks and the skipping rope exercise was continued till 12 weeks. The results revealed that in the experimental group statistically significant reduction in BMI rate was seen whereas in the children in the control group who did not received the intervention develop statistically significant higher BMI rate. This indicates that exercise intervention as lifestyle change in the obese children led to manage body weight, BMI, fat mass and others in obesity.

4.1.3 Theme 3: Impact of active video gaming within lifestyle of children suffering from childhood obesity

The presence of higher body mass and obesity is often related to the sedentary lifestyle of children where they greatly involve and spend increased time in watching television and playing video games. This is evident from the study of Hatta et al. (2017) where it is mentioned that parents did not limit the children in spending time on computer games and television that acted as potential risk factors that led the children to develop obesity or become overweight. Thus, in this respect, studies are analysed to determine to what extent active video gaming lifestyle could be linked with lowering obesity prevalence in children. In the study by Duman et al. (2016), the key aim was to determine the impact of active video gaming along with music accompanied callisthenic and aerobic exercise on the health of the obese children. In this purpose, the study included 21 males and 29 females who were overweight and obese with no presence of chronic or genetic disorder. The study calculated the impact of the strategy by examining BMI rate, waist circumference and physical performance of the participants before and after the intervention. The results revealed that due to the active video gaming and exercise activity 7 reached normal weight along with 23 remained slightly overweight and 20 participants remained obese. The BMI rate calculated among the participants revealed that it significantly reduced more in male children compared to female. In addition, statistically significant reduction in waist circumference was also seen among all the participants. This indicates that avoiding the sedentary lifestyle of playing video games in an inactive way resulted obese children to develop improved health with lower BMI revealing reduction in obese state. In similar, the study by Huang et al., (2017) determined the impact of active video gaming on fitness and motivation to execute physical exercise in overweight or obese children. This is because normal video gaming is often related with the sedentary activity that lowers physical efficiency to execute exercise among children. For this purpose, 14 children were involved in the study who were involved in using Xbox Kinect and Ninetendo Wii for nearly 1 hour daily till 8 weeks for playing purpose. The results revealed no significant changes in the vital physical signs, body mass index, muscular strength and flexibility among children. An average and peak health report regarding the activity informed that the obese children were able to execute active or vigorous intensity of exercise during each session. Therefore, the results revealed that the weight-week active video gaming program was not sufficient in showing proper changes in the fitness or motivation or physical changes among the obese children. However, it could be alternative strategy of involving obese children in executing exercise and physical activity.

4.1.4 Theme 4: Barriers to achieve impact of diet and lifestyle changes among children suffering from obesity

The living environment along with family is found to have a great influence to create diet and lifestyle changes among obese children. In relation to this, the facts presented by the study of Penilla et al. (2017) is been mentioned. The facts in the study are gathered through in interview of 29 parents of children who were obese and aged 2-5 years. The results revealed that employment of the parents is one of the major issues that is creating barrier in making healthier diet changes in their children. Moreover, the data revealed that inappropriate day care accompanied by presence of adjacent fast food environment along with unhealthy community eating activities are creating barrier for the parents to create healthier diet changes among the children suffering from obesity. In similar, the study by Staiano et al. (2017) also explored the barriers created in influencing healthy diet and lifestyle changes among children with obesity. For this purpose, the study developed focus group discussion that included 21 parents of obese children and 1 federal qualified healthcare worker. The results revealed that parents report lack of time to care for the obese children has led them to face barrier in successfully make diet and lifestyle change in coping obesity. Moreover, the lack of money to buy healthy foods along with lack of education about the exercise options for obese children has created barriers for the parents and obese children in achieving healthier diet and lifestyle changes.

4.2 Discussion

The review of the existing articles regarding diet revealed that changes in dietary pattern towards having healthy food have an enhanced impact on managing obesity suffered by the children as it helps them reduce their body weight. This is evident from the study of Jones et al. (2020) where it is reported that fruit and vegetables do create positive impact in reducing overall body weight and BMI rate obese children. This is because fruit and vegetables are high in fibre and water along with low-calorie content which creates a satiating effect on the obese children. The satiating effect is signal of the hormones in the body to the brain in mentioning that the meal is over and hunger is resolved. It eventually leads the obese children to avoid overeating which usually increases unwanted fat and calories to be added in turn avoiding the weight of the body to be maintained towards normal (Nour et al., 2018). In comparison, the study by Notario-Barandiaran et al. (2020) mentioned that having Mediterranean diet by the obese children is effective nutritional change that impacts obese children overcome obesity. This is because the diet is calorie-restricted with presence of unsaturated fats that impact on the body to lower lipids, in turn, avoiding deposition of fats in the body which was responsible for making the children obese. In contrast, the study by Kim et al. (2017) mentioned that change to eating more red meat and chicken is effective for lowering blood pressure and obesity in children. The obese children are usually found to have high blood pressure because the fatty tissues create pressure on the blood vessels in making them work with increased efficiency under resistance to delivery blood flow to all parts of the body (Xu and Xue, 2016). Therefore, change to meat eating is a healthy option for the children with obesity as it impacts to lower their high blood pressure and reduce fat deposition in the body, in turn, reducing overall body weight and BMI rate. This is because the meats are less in fat content, in turn, avoiding input of fat in the body of the obese children that could impact them in becoming more severely obese. In comparison, the study by El Amrousy and El-Afify (2020) indicates that intake of vegetables with alpha-lipoic acid as supplements are effective to reduce obesity in children. This is because alpha-lipoic acid contributes to create enhanced energy expenditure and decrease food intake along with suppresses hypothalamic AMP-activated protein kinase activity which are responsible for raising body weight (Bobe et al.., 2020). The vegetables that contain alpha-lipoic acid are spinach, yams, borocoli, potato and others which after entering the body develops energy, in turn, avoiding calorie deposition in the body that results in rising weight of the obese children (Bobe et al.., 2020). Thus, the studies in respect to diet change indicate that the obese children by involving in healthy diet as change from eating fast food would have the impact of experiencing lower BMI rate and reduction in body weight and blood pressure in leading a healthy life. The study by Desalew et al. (2017) mentioned that sedentary lifestyle has relation with obesity among children. Therefore, change towards having an active lifestyle that includes physical activity is required. In respect to this, it is revealed by the studies of Coimbra et al. (2017), Ham et al. (2016) and Lu et al. (2018) that inclusion of physical activity through school-based physical exercise program in the lifestyle of the children is mentioned to be effective to lower their body weight. This is evident as the studies show effective reduction of BMI, body weight and fat among the study participants who are obese children. The lifestyle change impacts the children to reducing body weight and overcome obesity because physical exercise results the body to create energy expenditure through burning of extra calories stored in the body, in turn, allowing the children to shed extra fats and lose weight making them avoid being obese and return to normal weight. Since children are seen to spent most of their time in the school where they get education for developing their future, the introduction of the change is creating active lifestyle for them in the school is the most suitable place. This is because they would get habituated to the activity as lifestyle under the curriculum which they may have ignored to be followed at home due to lack of guidance and rule along with less time to be spend in making the change (Pozuelo-Carrascosa et al., 2018). In support to the previous studies, the study by Brasil et al. (2020) also mentioned that involving obese children in judo as physical activity for lifestyle change impacts them to lower their body weight and reduce unwanted fat to lead a healthy life without obesity. This is because judo is also another form of physical exercise in which stored calories and extra fat in the body are burnt to produce energy, in turn, acting to help the obese children gradually develop normal body shape. In the study by Cvetković et al. (2018) use of recreation football playing as change is mentioned to be more effective change in lifestyle of the obese children compared to involving only in physical exercise. The football playing creates enhanced impact on the health and physical efficiency of the obese children instead of only physical exercise as it regularly engages them into moderate to vigorous physical activity that is important to shed increased body weight as well as avoid deposition of unwanted calories in the body by burning to create energy required during physical activity. Therefore, it is seen that change towards active lifestyle impacts the obese children to reduce body fat, BMI rate and body weight to gain normal body structure and weight which is healthy for their well-being in life.

In the modern era, it is seen that more children are involved in paying video and computer games in their leisure hours and made it their lifestyle for spending free time. However, the change towards involving in active video gaming that includes exercising activity along with playing is seen to have an enhanced impact on the obese children in reducing their increased weight. This is because it has led them avoid being sedentary in their free time and remain active in their lifestyle without much stress. It is evident from the study of Hatta et al. (2017) where it is mentioned that active video gaming is effective on the obese children to remain physical active and lower fat deposition in the body, reduce BMI rate and body mass. This is because active video gaming is different from conventional computer games where the children require sitting for prolonged hours and involving in playing. In active video games, the children require to make body movement and perform physical actions to play that reduce their sedentary time and lifestyle. This changes, in turn, impacts the children to avoid deposition of calories in the body due to lack of activity which often leads them to become obese. However, the study by and Huang et al., (2017) contradicts the facts and mentions change to active video gaming as lifestyle has no effect on weight reduction or other in obese children. Thus, it cannot be ensured whether or not active video gaming in an effective lifestyle change that impact children suffering from obesity overcome weight issues to led a normal life. There are few studies that mention barriers are created for the children suffering from obesity to receive the positive impact through the changes in their diet and lifestyle. This is because of the lack of suitable care environment and lifestyle management of the children by the parents on whom the children are responsible in accessing care. The children are dependent on the parents in the growing years and adolescent stage as the children are unable to have adequate efficiency in taking their own care and determine lifestyle at the specific stage (Suiraoka et al., 2017). In the studies by Penilla et al. (2017) and Staiano et al. (2017), it is mentioned that lack of adequate time and money are the key barriers in establishing the impact of lifestyle change on obese children. It is evident as due to work pressure the parents are unable to spend enough time in cooking and providing healthy diets such as vegetables and others to the children. It eventually leads the parents to provide processed and readymade fast food to the children to meet their hunger, in turn, failing to create success diet changes required to overcome obesity in the obese children (Cyril et al., 2017). Moreover, the increased expenditure required buying fresh vegetables and fruits compared to fast foods lead economically weaker parents to fail in buying the products, in turn, unable to create effective diet change for the obese children. The studies also inform that adjacent fast-food environment and easy availability for the children is a major barrier in making diet changes in the children. It is evident as easy availability of fast food would eventually lead the obese children have fast food instead of making diet changes as they are easily able to bought and great in taste (Penilla et al., 2017; Staiano et al., 2017). This in turn creates failure towards making diet changes that have positive impact on the health of the obese children. The lack of education about the importance and nature of physical activity is mentioned to be another issue for obese children in making lifestyle changes to attain positive impact on their health. It is evident as without knowledge of the way sedentary lifestyle activity are to be resolved and active lifestyle is to be developed by the children and their parents, it is impossible for them in making a successful change as they would be confused and doubtful about what actions to be taken to access the effects of multi-disciplinary lifestyle change for obesity. These barriers are been explored to mention suitable recommendations at the end of the research so that the way successful implication of the impact of the diet and lifestyle change being discussed for children suffering from obesity can be achieved.

Chapter 5: Conclusion and Recommendation

5.1 Conclusion

The research informs obesity among children has become a leading cause that requires resolution as it is causing children to develop different health complications such as cardiovascular disease, diabetes, sleep apnoea and others. The increased intake of fast foods, lack of physical exercise, extensive sedentary way of living, increased spending of time on television and sedentary games and others are responsible in causing higher prevalence of obesity among the children. This is because fast foods include high amounts of calories with less amounts of nutrients which leads to the children unable to satisfy their hunger and develops into overeating. It is evident that with an intake of high calories with no nutrients there is a limited satiating impact on the children, in turn, leaving them hungry. The lack of physical activity as lifestyle makes the children unable to burn the extra calories in the form of energy which contributes to raise the overall body weight of individuals. Moreover, the increased spending of time on television and computer games leads the children unable to create opportunity to exercise physically in overcoming obesity. The literature review informs that diet and lifestyle of the children are influenced by family environment, parental interference, education level of the parents and others. The model such as Healthy Eating Pyramid and Socio-ecological model of physical activity is effective framework to be followed to promote diet and lifestyle change among children as they inform systematic actions to be taken in making the change. The literature also reveals that Health Belief Model along with Theory of Planned Behaviour and Social Cognitive theory are effective frameworks to be used in influencing behaviour change regarding diet and lifestyle among obese children. The intake of whole grain, fresh vegetable and others along with aerobic exercise is mentioned as the nature of diet and lifestyle change required for the children suffering from obesity. The results gathered revealed that fruits and vegetables, chicken consumption, red meat and others are effective diet change that impacts the children with obesity in losing weight and extra body fats to develop normal body structure. In respect to lifestyle change, the results mentioned that it impacts the children suffering from obesity develop lower body mass, BMI rate, waist circumference, abdominal fat and others. However, avoiding sedentary activity of playing video games and involving in active video games as lifestyle change cannot still be assured of creating positive impact of reducing body weight of the obese children. Moreover, barriers such as lack of awareness of making lifestyle change, easy availability of fast food, lack of health education among parents and others are few of the potential challenges that is creating hindrance in establishing the impact with diet and lifestyle change among obese children. This is because the barriers are not allowing the change to occur, in turn, leading the obese children to suffer health issues.

5.2 Recommendations

In order to successfully implement the impact of diet and lifestyle changes for children suffering from obesity, the following recommendations are to be followed:

Creating awareness: The children along with the parents are recommended to be made aware by the health professionals, teachers, school authorities, community workers and others about the importance of diet and lifestyle change in obese children in relation to their current diet and unhealthy lifestyle choices. Moreover, the children and the parents are to be made aware of the way their current unhealthy choice of diet and lifestyle is gradually deteriorating their health by not only promoting severe obesity in children but also additional health issues. This is because it would make the children and parents develop perception of the need for change of diet and lifestyle. The information is to be provided with adequate evidence to the children and their parents so that they do not doubt the facts and understand the value of the change. It is required to avoid the children and parents doubts the facts and consider them to be fraudulent. Educating children and parents regarding physical activity: The children and the parents are to be educated about the nature of physical activity changes that are to be made in the lifestyles of obese children so that the children can have better health condition. The parents are also to be educated regarding the way they can intervene in lowering sedentary lifestyle of their obese children by reducing sedentary time and actions among the children. This is because lack of education among the parents about the way of institutionalising physical activity within lifestyle of their children, it has led them to act inappropriately in establishing active lifestyle of the children. Lowering surrounding fast food outlets: The easy availability of fast food is recommended to be avoided for the children. In this purpose, the presence of fast food outlets near the schools and neighbourhood is to be avoided. This is because it would make the obese children unable to crave for fast food that are not more easily available, in turn, making them opt for healthy diet which would be beneficial for improving their health conditions regarding obesity. Inclusion of healthy diet in school: The children are to be introduced to healthy diet in the school and active information is to be shared for the obese and the normal children regarding the benefits of healthy diet. This is because it would not only make the obese children understand the importance of healthy eating but also would make the normal weight children avoid involving in eating fast food which possess risk for them to develop obesity in later period.

5.3 Limitations of the Study

During the execution of the research, few limitations are being faced in accomplishing it. One of the key limitations faced is lack of enough time to effectively accomplish the study. Moreover, there was financial constraint due to which many potential paid journals and articles could not be used in the study that could have enhanced the validity and credibility of the research. In the study, the use of secondary studies led to limit the gathering of first hand data that include direct information from the participants that could have led to enriched presentation of information.

5.4 Implication of the study

The present study is able to be implemented in creating awareness among the teachers, school authorities, government and parents about the importance of diet and lifestyle change towards the health of the obese children. Moreover, it could be used to determine what nature of diet and lifestyle changes in obese children is required in accessing the potential impact of increased physical strength, less body, lower BMI rate and others. It could also be used by nutritionist and school authorities at reference to inform specific impact of diet and lifestyle change in children with obesity.

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