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EMOTIONAL TOLL & OBESITY IN CHILDREN UNDER 12 YEARS IN AUSTRALIA

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EMOTIONAL TOLL & OBESITY IN CHILDREN UNDER 12 YEARS IN AUSTRALIA
TITLE:
EMOTIONAL TOLL & OBESITY IN CHILDREN UNDER 12 YEARS IN AUSTRALIA
BACKGROUND AND STUDY RATIONALE:
Obesity refers to a clinical condition that leads to the accumulation of excessive or abnormal fat in the adipose tissue. Globally, pediatric obesity has been escalating and has now reached epidemic levels. Pediatric obesity is known for having crucial impacts on both the physical and psychological health of children.
Notably, this condition is fatal in that a child may remain obese for a long time and become susceptible to conditions like diabetes and cardiovascular illnesses at an early age (Bastien et al., 2014).
Besides these physical health advancements, pediatric obesity also has an emotional toll. Frequently, pediatric obesity has been linked to social stigma, decreased self-esteem, school bullying, depression, emotional eating, and discrimination (Salwen et al., 2015). As such, this study focus is on the emotional toll of obesity among children with obesity in middle-income families.
The rationale for this study is that childhood obesity is an increasing problem in Australia. Studies suggest that three times as many children are overweight or obese now than 30 years ago. Current estimates in Australia suggest about 20% (1 in 5) children are overweight or obese (Bullying and Obesity in Children, 2014, November 10).
Study Objective(s):
To gain understand the emotional toll of obese children. The results of this study will help determine the most effective ways to support children with obesity emotionally and physically.

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Central Hypothesis:
Obesity among children under twelve years of age in Australia has an emotional toll.
There is a distinct association between the level of physical activity, food consumption pattern and pediatric obesity.
Stigmatization of obese children is due to attitudes of parents, teachers and fellow students.
Research question:
Are the level of physical activity and food consumption related to pediatric obesity?
Do the attitudes of parents, teachers and fellow students stigmatize obese children?
Does the emotional toll of obese children from the Gilmore elementary school, Australia, affect their development and academic performance?
How does the structure of a family affect the prevention of pediatric obesity?
Research Methods and Approach:
Study Design/Type:
A Prospective Cohort study design will be adopted and followed longitudinally for 24 months after the changes made in lifestyle (school physical activity and food consumption) and counseling.
Study Location and Setting
The area of study will be in a middle-class neighborhood (Heagney Crescent,
Gilmore, Australia.) And a local elementary school (Gilmore primary school).
Study Population/Subjects:
The study population comprises of children under 12 who are obese and come from middle-class households in Australia. The exclusion criteria for the subjects are children who are more than twelve years; come from poor or upper-class families; and those who are underweight or have normal body weight.
Primary Exposure/Primary Outcome
The primary exposure in this study will be pediatric obesity. This is because pediatric obesity is the exposure of interest.
The main outcome of the exposure (pediatric obesity) is an emotional toll (which may include stigma, depression and emotional eating).
The main outcomes will be measured by interviews, with a questionnaire (parents, school, and student or child) as a base and conducted at a specific time intervals by the study member. Collected data will comprise the results of food consumption, physical activity, parent involvement in the child’s activities and behavior of the child in school will help growing children to grow healthy physically and emotionally.
School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005.
Secondary Exposures or Factors:
Family environment is the secondary exposure or factor for this research study. The family environment is critical for weight loss, especially for children and adolescents. Family characteristics that were assayed against the backdrop of pediatric obesity included the number of children and family structure (single-mother or 2-parent family structures). Chen, Jose, and Escarce (2010) recommend that health care providers factor in these aspects of a child’s background when assessing pediatric obesity. Indeed, family relations are the principal source of education for children on sociability, influence, and experience in and the borrowing of healthy lifestyles (Gruber & Haldeman, 2010).
Secondary Outcome(s):
Academic performance is a primary motivator for this-this study; therefore, the effect of the exposures (obesity and family environment) on academic performance is just as crucial, if not consequential, to the emotional toll exerted on children by them. Poor student health has overwhelming evidence linking it to academic failure, retention at grade levels and student dropout (Shaw, Gomes, Polotskaia & Jankowska, 2015; Fuxa & Fulkerson, 2011). Grade retention and dropout rates will provide insight into the particular effect of childhood obesity on academic performance in this study.
Study Procedures:
With the signed consent form from their parents, children aged between 6 and 12 years at Gilmore Elementary School from single-mother or 2-parent families were sampled to participate in this study. They underwent an initial measurement of height (with a wall-mounted stadiometer) and weight (with a balance-beam scale) for calculating their BMI that were repeated bi-annually over the next three years. These prospective measurements were accompanied with a record of their academic performance (from their school). Moreover, in each instance of recording, the students filled a questionnaire that assayed their family structure, nutrition patterns and levels of physical activity with the assistance of a trained investigator. They also went through interviews with certified psychiatrists that assessed their psychological state for mood disorders.
Data Elements/Variables:
Age
Level of education
Body Mass Index
Anxiety level
Depression level
Food intake
Physicality
Family structure
School performance
Data Management, Analytic Plan, and Statistics:
The data collected was managed by a close-knit research team keen to keep personal details out of the publication or outside interests. Multivariate regressions were conducted, and the primary explanatory variables for obesity and academic performance were food intake (1-5 Likert scale) and family structure (single-mother or 2-parent families, number of siblings). Co-variates included age and level of education that were an indicator of independence of habits and were rightly adjusted in the analysis. Standard errors and errors due to non-response were adjusted with the Huber-White sandwich estimator. The analyses were conducted with Stata 10.
Sample Size and Feasibility:
150 students to participate in the study. This sample size was limited to the singular source of participants, Gilmore Elementary School. With a significance level of 5 percent, this fundamental study would do with a power of 80 percent since an alpha error would not have dire consequences (Dell, Holleran & Ramakrishnan, 2002). The standardized effect size would be 0.4 to meet the sample size that is available (6. Power and sample size).
The students are likely to be active throughout the study period as moving them to other schools is not favored by them, their parents or school faculty alike. Dire scenarios that might cause non-response might include family emergencies, indiscipline cases, poor child health or death. The study sample will be under constant supervision and is likely to remain feasible with only a few instances of non-response.

References
“6. Power and sample size,” Retrieved from http://www.3rs-reduction.co.uk/html/6__power_and_sample_size.html
Bullying and Obesity in Children. (2014, November 10). Retrieved from https://www.myvmc.com/lifestyles/bullying-and-obesity-in-children/
Gilmore Primary School. (2005, October 12). Home. Retrieved from http://www.gilmoreps.act.edu.au/
Bastien, M., Poirier, P., Lemieux, I., & Després, J. P. (2014). Overview of epidemiology and contribution of obesity to cardiovascular disease. Progress in cardiovascular diseases, 56(4), 369-381.
Chen, A. Y., & Escarce, J. J. (2010). Peer reviewed: Family structure and childhood obesity, early childhood longitudinal study—kindergarten cohort. Preventing chronic disease, 7(3).
Dell, R. B., Holleran, S., & Ramakrishnan, R. (2002). Sample size determination. ILAR journal, 43(4), 207-213.
Fuxa, A. J., & Fulkerson, J. A. (2011). Adolescent obesity and school performance and perceptions of the school environment among Minnesota high school students. School Mental Health, 3(2), 102-110.
Ogden, C. L., Carroll, M. D., Fakhouri, T. H., Hales, C. M., Fryar, C. D., Li, X., & Freedman, D. S. (2018). Prevalence of obesity among youths by household income and education level of head of household—United States 2011–2014. Morbidity and Mortality Weekly Report, 67(6), 186.
Parahoo, K. (2014). Nursing research: Principles, process, and issues. Macmillan International Higher Education.
Salwen, J. K., Hymowitz, G. F., Bannon, S. M., & O’Leary, K. D. (2015). Weight-related abuse: Perceived emotional impact and the effect on disordered eating. Child abuse & neglect, 45, 163-171.
Shaw, S. R., Gomes, P., Polotskaia, A., & Jankowska, A. M. (2015). The relationship between student health and academic performance: Implications for school psychologists. School Psychology International, 36(2), 115-134.

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