Reducing Obesity in Children Using the PICO (T) Approach


The PICO (T) approach to meeting patient needs is useful in developing care practices for the patient. This paper will examine the application of the PICO (T) process in reducing childhood obesity. There will be an identification of several sources of evidence to help find answers to the problem. Findings from the various articles will undergo analysis that will aid in identifying their relevance.

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PICO (T) Question

The following question will be a reference point for this paper: Can childhood obesity (P) be reduced through a lifestyle change (I) or increased physical activity (C) to reduce the risk of cardiovascular disease (O) when they reach adulthood (T).

Why Childhood Obesity is a Clinical Problem

In the recent past, more obese children are presented for surgery as a result of comorbidities they acquire due to obesity. According to the World Health Organization (n,d), obesity is a health challenge that has become common in children in most Western countries. It is a significant contributor to type 2 diabetes and the risk of heart disease in adulthood. Obesity is a result of consuming too many calories that the body can burn. Calorie intake usually is in the form of sweetened beverages and a lack of exercise. Other than overeating and lack of enough physical activity, the child’s genes can also predispose them to obesity. Childhood obesity increases the risk of the child to develop other complications such as precocious puberty, pancreatitis, Blount disease, cholecystitis, depression, sleep disorders, hypertension, stroke, sudden death, among others. This is the reason why nurses should be at the forefront to provide health education and other interventions to reduce instances of childhood obesity. 

Timely interventions and obesity prevention measures help the individual avoid complications brought about by obesity when they become adults. Nurses support the children and their parents by providing health education on healthy ways of eating and strategies for increasing the hours of physical exercise for the child. The health education that the nurse disseminates should be family-based as a child cannot have a lifestyle change without support from other members of the family. The nurse should also involve other healthcare providers in addressing the issue since it is a significant health issue that has long-term morbidities (WHO, n,d). 

Sources of Evidence

           An article by Pandita et al. (2016) emphasizes the importance of preventing childhood obesity rather than curing it. The authors state that an assessment of obesity should be done in consideration of an individual’s environment, genetics, and developmental factors. They further argue that an obese child will most likely carry the condition into adulthood, where it will become even more challenging to lose weight. An individual who enters adulthood obese is at a high risk of chronic illnesses such as cardiovascular disease, diabetes, hypertension, and many others. The authors of this article suggest three ways of preventing obesity in children; first, there should be an effort for the child to maintain a healthy weight by continually looking at the BMI in childhood and as a teenager; this is what they call primordial prevention. Secondly, there should be primary prevention interventions to prevent an overweight child from being obese. Thirdly, there is a secondary prevention intervention that deals with treating obesity to reduce comorbidities and reverse the condition if possible. 

Weihrauch-Blüher et al. (2018) delve into current guidelines for preventing obesity in children and adolescents. Their study emphasizes the need for tackling the issue in age groups. The study found out that interventions that involve pre-schoolers should incorporate both the teacher and the parent, whereas, in adolescents, the main focus should be on them and not their parents. The study also says that interventions in children under 12 years are more effective than when they are past this age. Interventions suggested in this study are community-based, and they include an hour of physical exercise at school, taxing of unhealthy foods, setting of meal standards in kindergartens, and banning of unhealthy food adverts that target children.

           Another study by Xu and Xue (2016) looks at the causes, prevention, and treatment of pediatric obesity. The authors opine that 34% of the children in the US are obese; this is attributed to overconsumption of fatty foods and diets high in sugar. According to the authors, in 2006, obesity used up 40% of the healthcare budget in the country. As we have seen in other studies, obesity in children is mostly as a result of unhealthy eating and lack of sufficient physical activity. Other than dietary changes and increased physical activity, the article promotes the use of surgical and pharmacological interventions to treat obesity.

           Sahoo et al. (2015) look at the causes and consequences of obesity in children. Childhood obesity is a vital factor in the development of coronary heart disease and type 2 diabetes. This phenomenon has risen in the past four decades, more so in the developed world. Obesity in children affects a child’s social, physical, and emotional well-being. Such children also perform poorly in school in addition to them having low self-esteem. The study concludes that the situation is manageable through the adoption of healthy eating habits initiated by the parents and increased physical activity.

Article That Best Supports Nursing Interventions in Preventing Childhood Obesity

           An article that supports interventions by nurses to prevent obesity in children is by Schantz (2011). The author states that almost 55 million children aged 5-19 years are either in an elementary or secondary school in the US; this represents 98% of all school-going children. These children spend a minimum of six hours a day, nine months a year at school. Therefore, a school nurse is one of the people who can effectively initiate measures to prevent the onset of childhood obesity. They have the potential to strengthen evidence-based nutrition and exercise behaviors in children; also, they help promote research, policy strategies, and evidence-based guidelines in the schools they work in. They can act as lobbyists to urge school administration to change policy, adhere to health guidelines, provide more education on nutrition, and also have a say on the type of food that is served in the school canteen.

           This study by Schantz (2011) is different from the other articles above as it tackles the problem at a different angle; the other articles were emphasizing more on interventions at home. Though this is a start in the prevention of childhood obesity, the same needs to be extended to school as children spend a lot of time in school than they do at home, nurses should take it upon themselves to weigh and measure children to determine their growth rate and BMI. Screening of children should start when they are six years old, and they should also receive counsel and behavior interventions if they are found to be at risk of being obese.

           Nurses should measure a child’s weight and height to determine BMI to establish if the child is at risk of health complications related to being overweight and obese. In measuring the weight, height, blood pressure, and BMI of children in addition to assessing for acanthosis nigricans and the child’s behavior on physical activity and nutrition, the nurse identifies children who need to be evaluated further. Screening of children should be done with the full knowledge and approval of parents. If they establish that a child is at risk of developing obesity, the same should be communicated to the parent in confidentiality (Schantz, 2011). Assessment of children at risk of obesity should be done accurately within the guidelines set out by the centers for disease control and prevention.


           Preventing obesity in children is an initiative that needs the input of the child and his family and the school nurse. If parents instill healthy eating habits in their children early in life, they will avoid being overweight and obese into their adulthood. This will reduce the prevalence of complications that come with obesity in adulthood; such complications include type 2 diabetes, stroke, hypertension, cardiovascular disease, and shortened lifespan. It is, therefore, safe to conclude that nurses play an essential role in preventing and reducing childhood obesity in the school setting. Nurses can also act as lobbyists in advocating for healthy food to be served at the school cafeteria and also promote regular physical exercise for the children. However, this can only be possible through the cooperation of the children, parents, and school administration. Once these goals are achieved, there will be less children presented for surgery to manage obesity.


Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., & Kaul, A. (2016). Childhood obesity: prevention is better than cure. Diabetes, metabolic syndrome and obesity : targets and therapy, 9, 83–89. doi:10.2147/DMSO.S90783

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of family medicine and primary care, 4(2), 187–192. doi:10.4103/2249-4863.154628

Schantz, S. (2011, June 20). The Role of School Nurses in Childhood Overweight and Obesity Intervention. Retrieved from

Weihrauch-Blüher, S., Kromeyer-Hauschild, K., Graf, C., Widhalm, K., Korsten-Reck, U., Jödicke, B., … Wiegand, S. (2018). Current Guidelines for Obesity Prevention in Childhood and Adolescence. Obesity facts, 11(3), 263–276. doi:10.1159/000486512

World Health Organization. (n.d.). Childhood overweight and obesity. Retrieved from, S., & Xue, Y. (2016). Pediatric obesity: Causes, symptoms, prevention and treatment. Experimental and therapeutic medicine, 11(1), 15–20. doi:10.3892/etm.2015.2853

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