Running Head: OBESITY AMONG CHILDREN IN JAMAICA 1

College of Allied Health and Nursing

Department of Nursing

Research Proposal

Factors Contributing to Obesity among Children in two Jamaican Primary Schools

Completed in Partial Fulfilment of the course:

NRSG 446: Nursing Research

Introduction

The predominance of obesity on Jamaican children is on the increase and will continue to

be a serious problem, if it is not addressed. Globally the prevalence of childhood obesity has also

significantly amplified. Once, merely contemporaneous in developed countries, childhood

obesity has now grown to an all-time high in developing countries. “The rate of overweight and

obesity in children in developed and developing countries is frightening. Overweight rates are as

high as 15 per cent and obesity is up to 10 per cent in some respects” (Jamaica Gleaner May 19,

2011)

INTRODUCTION

Adequate nutrition plays an important role in the life of human beings, particularly

children who are still growing (). For children to grow to their full capacity they must be

properly fed (). However, there is an age old belief, particularly in Jamaica that slim children are

under nourished or sick, while fat or obese children are quite healthy and well nourished. Given
OBESITY AMONG CHILDREN IN JAMAICA 2

this belief, many parents in Jamaica do not monitor their children’ eating pattern or activity

levels. According to (reference) eating habits and lack of activity levels are major contributing

factors to childhood obesity. The authors further stated that parents and caregivers are the ones

mainly responsible for monitoring children’s eating habits, which if neglected could lead to

problems.

Statement of the problem

The researchers, who through observation and interactions with children, parents,

caregivers and health professional have realized that obesity is an increasing problem,. This

problem is observed in school aged children, particularly at the primary level. These children

have been seen and weighed; they were more than xkg above the required weight for height and

age. Among the problems that were observed and reported was shortness of breath, low self

esteem etc…….. (State some of the things childhood obesity can or has caused or that you have

observed…then find something with reference and statistics to back you up) (Say what will

happen if the problem is not addressed with reference and statistics)

Significance

(This says how widespread the problem is, start with local, caribbean and then worldwide)

During the search of literature in jamaica, no studies that spoke to the dimensions of this problem

were found. However, there were several newspaper articles that spkoe to the extent of this

situation. For example………..(give some statistics) in the caribbean childhood obesity takes on

similar epic proportion. According to ………….globally, the problem takes on a similar

magnitudinous proportion. For example……….(give some statistics to say why it is

magnitudinous).
OBESITY AMONG CHILDREN IN JAMAICA 3

If the problem of childhood obesity is not addressed, it will have far reaching effects on

children, family life and hospital resources. This is supported by () who stated that the effects of

childhood obesity are far reaching. They highlighted the following effects (effects on children,

effects on family, effects on hospital resources)………..

It is against this background that the question is asked, “what are the factors that

contribute to obesity in children attending primary schools in Kingston and Saint. Andrew

Jamaica?” The findings from this study will be beneficial to all stakeholders (name the

stakeholders) and will ultimately improve the nutritional status of primary school children

Purpose

This research intends to identify the factors that contribute to obesity in Jamaican children

attending primary schools in Kingston and Saint. Andrew. The findings when completed will be

disseminated to (name all the concerned parties). Further, it is hoped that the results will help to

strengthen policies on child nutrition and ultimately reduce obesity.

According to Davies and Fitzgerald (2008) childhood obesity is “the presence of

excessive accumulation of adipose tissue that interferes with a child’s health and well- being.”

Obesity has definitely interfered with the health status of children in that it leads to death which

could have been prevented. Further, it has been associated with many significant health problems

known to have psychological effects on an individual. Some of these psychological problems

include; lack of physical activity, genetics, dietary intake, socioeconomic status and sedentary

activities have been the considerable causes of childhood obesity. An article published by the

Jamaica Information Service (2012) entitled Government Tackling Childhood obesity

OBESITY AMONG CHILDREN IN JAMAICA 4

highlighted that childhood obesity continues to be a serious problem in Jamaica with more than

11% of children 10-15 years classified as obese.

Problem: Childhood obesity is very prevalent in our society. It has become a concern for

the future generation. Its disadvantages and complications such as diabetes and hypertension

make it a tackling problem for health care workers. According to an article in The Star, Dietician

in the Ministry of Health, Deon Bent, stated that there are surveys that indicate this growing

trend in the nation's youth such as a healthy lifestyle survey of 2000, which indicated that one

out of every five children between the ages of 9 and 11 years is overweight or approaching

obesity.

Purpose: To identify the factors that contributes to childhood obesity, among school

children within the age group 6-12years attending primary school within the metropolitan areas

of Kingston and St. Andrew. On completion of the study, findings will be disseminated to

Kingston and St. Andrew Health department (KSA), The Ministry of Education and parents, so

that policies regarding proper nutrition among children can be strengthened. Further it is hoped

assist with the implementation of strategies that will help in the reduction of childhood obesity.

The roles of the nurse include being an educator, health promoter and counselor. This research

will advance nurses proficiency as they function in fulfilling these roles through evidence- based

practice they will be able to provide effective parental education/ guidelines on how to prevent

childhood obesity by identifying factors that predispose children to this condition.

Hypothesis: Sedentary activities, genes, socioeconomic status, poor monitoring of

physical activities, and dietary intake contribute to obesity in Jamaican children in the age group

6-12 years attending primary schools in Kingston and St. Andrew

OBESITY AMONG CHILDREN IN JAMAICA 5

LITERATURE REVIEW

According to Rush-Wilson (2007) obesity is defined as, “a condition in which a person’s

weight is more than 20% greater than is recommended for his or her height or age.” On the other

hand, Davies and Fitzgerald, (2008) posits that childhood obesity, is “the presence of excessive

accumulation of adipose tissue that interferes with a child’s health and well- being”. This

suggests that obesity in children is excessive fat that affects their health as well as their self

esteem/image, which is occurs when weight exceeds age and height.

When weight begins to exceed age and height, children are on the path to health problems

that were once limited to adults. These health problems include hyperlipidemia, hypertension and

diabetes, simply of excessive intake and reduction in metabolism caused from limited physical

activity. McLennan (2004), in a study on childhood and adolescent obesity in Australia, concurs

with this situation. He posits, “The causes of obesity and/or overweight are multifactorial, these

include changes in energy intake and expenditure related to both refined and evident movements

in societal behavioral habits.” Similarly, studies such as (), have highlighted that the factors

These factors will be elaborated on, to identify its impact on childhood obesity.

In reviewing the literature of Wake and Reeves (2012), it was highlighted that, “low

levels of physical activity have long been associated with increased risk of obesity, and children

who spend greater amounts of time in front of computer or television (TV) screens seem to be at

greater risk.” This situation is a reflection of what generally obtains in Jamaica, where children’s

participation in leisure or recreational activities are at a minimum (jump rope, dandy shandy etc),

this is due largely to increase in technology. A study was carried out to explore the link between

watching television and obesity in Saudi Arabian children of school-age. Al-Ghamdi (2013)

stated that, “watching television causes obesity through at least one of the following
OBESITY AMONG CHILDREN IN JAMAICA 6

mechanisms: displacement of physical activity, increase calorie consumption and reduced resting

mechanism.” Children tend to participate more in sedentary activities than physical activities,

thus increasing their risk for obesity. They often spend their time watching television, using the

computer and other technological gimmicks while they consume high calorie foods. Studies

have showed that technology increases unhealthy food choices as food advertisements are very

persuasive and appealing. Wake and Reeves (2012) stated, “sedentary behavior may also be

associated with increased snacking, and it has been reported that television viewing has often

been associated with passive eating and the consumption of fast foods and confectionary.”

Genetics has been an associated factor of childhood obesity, in that; parental obesity

predisposes children to becoming overweight. According to Kornides, Kitsantas and Villarruel

(2011), Parental obesity is one of the strongest correlates of childhood obesity. In families with

two obese parents, almost 80% of White children will develop obesity. It is unclear if the

interfamilial relationship of adiposity is caused more by environmental influences or genetic

influences.” However, Okosun, Liao, Rotimi, Dever, & Cooper (2000) has proven otherwise, “a

study using data from the NHANES III found birth weight to be negatively correlated with

excess adiposity in children ages 5 to 11 years regardless of their ethnic or racial group.”

Nevertheless, based on the researches done, it can be concluded that regardless of one’s ethnic

background, children are at high risk of becoming obese once genetics lies as a predisposing

factor.

Genes and Socioeconomic status often walk hand in hand ss they help to shape who the

child eventually become (). According to Kornides, Kitsantanas and Villar (2011) socioeconomic

(SES) influence obesity in children, as a low income prevents appropriate medical care for

children. Kornides et al (2011) further posited, “it has also been suggested that lower SES has an
OBESITY AMONG CHILDREN IN JAMAICA 7

effect on obesity through food insecurity. SES has been negatively associated with risk of food

insecurity or insufficiency, which is hypothesized to be related to increased adiposity.” Food

insecurity has to do with having inadequate accessibility of nutritious food choices. In addition,

“researchers hypothesize that food insecurity causes rebound overeating during times when food

is abundant,” Kornides, Kitsantas and Villarruel (2011). Reason being, if parents are unable to

buy the more nutritious food, they well settle for the cheaper food choices that tend to be more of

a high fat, unhealthy food choice. However, many will argue that there are many nutritious foods

that are less expensive and proven thus to have less impact on obesity.

Theoretical Framework

According to Burns & Grove (2009), “theories are an important source for generating

research problems because they set forth ideas about events and situations in the real world that

require testing.” In this research, the health promotion / theoretical model clearly relates to our

topic: factors contributing to childhood obesity in Jamaica. Health promotion is the ethical

approach towards acquiring good health. According to Davies & Macdowall, “the World Health

Organization in 1986 stated that health promotion account for new health challenges and a better

understanding of the economic, environmental and social determinants of health and disease.”

In a study of children it was found that most common barriers to reducing saturated fat in

the diet were (a) giving up preferred foods (b) meals outside the home that contained fat,( c) not

knowing what foods were low in fat and (d) not wanting to take time to read the labels. Another

individual characteristic used in the study was access to low fat food. This concept from the

Health Promotion Model is important in a middle school aged populations, as they are to some

extent, dependent on others for types of food available (Burns & Grove, 2009). Dietary intake
OBESITY AMONG CHILDREN IN JAMAICA 8

has a remarkable impact on the health status of children. They prefer to liberally consume high

calorie, and carbohydrate rich foods which contribute immensely to obesity. They are unable to

make substantial decisions about food choices.

METHODOLOGY

Research Design

For the purpose of this study a descriptive research design will be used. This design will

describe the characteristics of the population involved in the study. “A descriptive study is one in

which information is collected without changing the environment (i.e., nothing is manipulated)”

(Nebeker dn). However, the variables in this study will not be manipulated and the researcher

will interact with the participants by the use of questionnaires, in collecting the necessary

information.

Site and Study Population

The target population of this study will be Primary school aged children 6-12 years old

who attend school in the parishes of Kingston and St. Andrew in Jamaica. This population was

purposively selected as the researchers have observed and spoke with children, (who were obese)

parents and caregivers of children within this age group (who had or cared for obese children).

Additionally, it was observed that childhood obesity among this age group is prevalent in

Kingston and Saint Andrew.

OBESITY AMONG CHILDREN IN JAMAICA 9

The Role of the Researchers

The researchers will accurately formulate a research proposal; outlining the steps and

format of the intended research. This proposal will then be submitted to the ethics committee for

a detailed review. In order to obtain the needed data the researcher will employ and train a team

of eleven (11) members. These members will be responsible for the accurate administration of

the self-developed questionnaire to research participants. On the completion of this study the

acquired data will be securely stored in a closed filing system.

Ethical Consideration

The execution of this study will abide by the standards outlined by the IRB. All subjects

will be treated fairly, confidentiality will be maintained, the research will be more beneficial with

minimal or no risk or discomfort to the patient. All information attained from secondary sources

will be cited accurately throughout the research project. Approval will be sought from the Ethics

Committee(s) of the school involved Kingsway and Saint Andrew Primary Schools as well as

from parents/gaurdians. Letters requesting permission, addressed to the Ethics Committee(s),

proposals, and completed checklists will be submitted to request permission to carry out the

research.

Selection of Study Participants

The sample size of the population (N) of obese children 6- 12 years who attend both

Kingsway Preparatory School and the St. Andrew Primary School respectively, will be

determined using the Raosofe sample size calculator. With the permission of the ethics

committee and parents, a list of the number of obese children enrolled in these schools will be

obtained. These will serve as a sampling frame from which participants will be selected.
OBESITY AMONG CHILDREN IN JAMAICA 10

Subsequent to obtaining the list, the total population will be grouped by age. Each student age 6-

12 will then be assigned a number. These numbers will be placed in a bag where a simple

random sampling method will be used to select the 100 students.

Inclusion criteria will compromise of obese children. They must be between the ages of

6-12 years and attending Kingsway and Saint Andrew Primary schools. Their weight must be

well above their required weight for their age. They must also participate in more sedentary

activities for approximately five (5) hours daily; have poor dietary intake; lack of physical

activities.

Data Collection Procedures- Instruments

The period October 8-12, 2013 will be used as the period of distribution and collection of

information. The data will be collected through the use of self-administered questionnaires;

developed by the researchers from the literature review and theoretical framewok. According to

Business Dictionary.com (2013), a questionnaire is defined as, “ a list of

a research or survey questions asked to respondents, and designed to extract specific information

which serves four basic purposes: (1) to collect the appropriate data, (2) make data comparable

and amenable to analysis, (3) minimize bias in formulating and asking question, and (4) to make

questions engaging and varied.” These questionnaires will consist of twelve (12) open and closed

ended questions that will be generated from the objectives. Each participant will be asked to read

the instructions carefully; then choose the most appropriate answer for each question. It is

mandatory that each participant must answer every question. Reliability and validity will be

obtained using a pre-test on October 7, 2013 where parents of 6-12 years old children from the

Half Way Tree Primary School will be asked to complete the same questionnaire. Before
OBESITY AMONG CHILDREN IN JAMAICA 11

completing these questionnaires; however, each participants is expected to complete a detailed

informed consent form which will be signed and returned to the researcher.

Procedures for recording data

An obesity questionnaire can help to find out whether children are on the threshold to

obesity or are already obese and the findings will aid in overcoming this disorder which can have

far reaching consequences on health. The approach that will be taken for recording qualitative

data research is that, the researcher will use self-developed questionnaires to find out the various

factors that contribute to obesity in children. While recording these data, confidentiality will be

maintained as participants will not be required to write their names on the questionnaires. These

questionnaires will be reliable and valid. Questionnaires are an important tool of epidemiological

and operational research. Given the nature of original research, a unique survey form will be

developed for each research project. The nature of the study and the setting in which the data will

be collected will influence the design and structure of the data-recording form or questionnaire;

however, the following general principles will be considered. The title of the study will appear at

the top of the survey form and will be clear and sufficiently detailed to inform collaborators of

the general purpose of the research.

Result/ Findings

It is our desire to make this research beneficial to the public, by increasing their

knowledge and awareness of the factors that contribute to childhood obesity in Jamaica

(specifically Kingston and St. Andrew region) using symposium as an effective teaching method,

publishing the abstract in the daily gleaner and submitting the findings to the Ministry of Health

and Kingston& St. Andrew Health Department.

OBESITY AMONG CHILDREN IN JAMAICA 12

Discussion/Limitations

Increase sedentary activities, decreased physical activities and genetics are factors that contribute

to childhood obesity in Jamaica. This research is intended to prove that more than fifty percent of

obese children in Jamaica are affected by more than one of these factors that contribute to

obesity in childhood.

A direct reference to a previous study on childhood Obesity in Jamaica will not be made

as the literature was not obtained prior to the study. The method of data collection enabled the

researchers to link the variables. Though a direct link can be made between these factors and

obesity, limitations restricted the percentage of accuracy of the study. Such limitations include:

A questionnaire will be used to collect data though it will not effectively evaluate how

the genetic factors contribute to obesity specifically for the participants in the study.

The research will not fully represent the entire school population of Kingston & St.

Andrew as only one school was purposively chosen to carry out this study

Conclusion

Conclusively; obesity severely compromises the health of individual’s and may, quite

possibly lead to death. It must be highlighted however, that numerous factors may contribute to

obesity such a; lack of physical activities, genetics, sedentary activities, dietary intake, and

socioeconomic status. Obesity has become a growing trend among school aged children, and as

such predisposes them to complications such as hypertension, diabetes, and high cholesterol

levels lifestyle diseases once predominantly occurring in adults.

OBESITY AMONG CHILDREN IN JAMAICA 13

In conducting this study, the researchers will seek to examine the various causes of

childhood obesity and its prominence within the Jamaican society. The findings from this study

will be used to aid in the organization of collaborative measures to develop health promotional

strategies. One of these strategies which should be utilized is that of public education.

Reference

Al-Ghamdi, S. H. (2013). The Association Between Watching Television and Obesity in

Children of School-Age in Saudi Arabia. Journal Of Family & Community Medicine, 20(2), 83-

89. doi:10.4103/2230-8229.114767

Burns, N., Grove, S. K. (2009) The Practice of Nursing Research Appraisal, Synthesis and

Generation of Evidence 6th ed.

Davies, H. D., Fitzgerald, H. E., & Mousouli, V. (2008). Obesity in childhood and adolescence.

Westport, Conn.: Praeger.

Davies, M., Macdowall, W. Health Promotion Theory.

http://www.sanjeshp.ir/phd_91/Pages/Refrences/health%20education%20and%20promoti

on

Nebeker, C. Research Design: Descriptive Studies.

OBESITY AMONG CHILDREN IN JAMAICA 14

http://ori.hhs.gov/education/products/sdsu/res_des1.htm

Wake, Y., & Reeves, S. (2012). Factors that influence obesity in children at primary schools in

England and France.International Journal Of Health Promotion & Education, 50(1), 2-9.

doi:10.1080/14635240.2012.661951

Kornides, M.L., Kitsantas, P., Villarruel, A.M.Factors associated with obesity in Latino children:

a review of the literature. (2011). Hispanic Health Care International,9(3), 127-136.

doi:10.1891/1540-4153.9.3.127

McLennan, J. (2004)Obesity in Children: Tackling a growing problem.

http://softballone.com/rfe/obesity.pdf

Rush-Wilson, T. C. (2007). The Crisis of Childhood Obesity: What You Can Do. Pediatrics For

Parents, 23(11), 3-5

Obesity in children on the increase, Retrieved from,

http://jamaica-star.com/thestar/20070821/news/news10.html

Tackling Childhood Obesity, Retrieved from, http://www.jis.gov.jm/news/bydate/31695-govt-

tackling-childhood-obesity

http://www.businessdictionary.com/definition/questionnaire.html

Obesity in Children. Wednesday, May 19, 2011. Retrieved from: http://jamaica-

gleaner.com/gleaner/20110518/health/health5.html
OBESITY AMONG CHILDREN IN JAMAICA 15

Appendix A

Budget

Refreshment $12, 500

Transportation/ Travelling $25,000

Training $16,500

Materials (pencil, pen, paper, stapler etc) $7,000

Facilitators stipend $231,000

Miscellaneous $10,000

Total $302,000
OBESITY AMONG CHILDREN IN JAMAICA 16

Appendix B

Informed Consent

PRINCIPAL INVESTIGATOR: Group 1

TITLE OF PROJECT: Factors contributing to childhood obesity in Jamaica, ages 6- 12 years old

This Informed Consent will explain your role as a participant in this research. It is important that

you read this material carefully and then decide if you wish to be a volunteer.

PURPOSE:

The purpose(s) of this research study is to identify the factors contributing to childhood obesity

such as:

1. The lack of physical activity

2. Genetics

3. Dietary intake

4. Socioeconomic status
OBESITY AMONG CHILDREN IN JAMAICA 17

5. Sedentary activities

DURATION

This study will take approximately 1 week. The data will be collected at the school’s Parent

Teachers meeting which will be held on Thursday October 11, 2013 at 3:00 pm. Only parents

with obese child/ children will take part in this study.

PROCEDURES

As the research subject, you will be required to complete a questionnaire comprising of twelve

(12) questions. Upon completion, the questionnaire should be returned to the facilitators.

POSSIBLE RISKS/DISCOMFORTS

There are no possible risk/discomfort as this survey only ask questions about the type of dietary

choices, lifestyle practices and the impact of socioeconomic status on your child’s health.

To protect your confidentially no name will be added to the questionnaire. Each form will have a

specific identification number known only to the facilitators and/ or research team. In addition, if

the study results are published or used for teaching, no names will be used.

POSSIBLE BENEFITS

This research will educate others on the importance of a healthy lifestyle and also you the

participant will have the opportunity to carry out and implement strategies to improve self-

esteem, life expectancy and lifestyle of your child.

CONFIDENTUALITY
OBESITY AMONG CHILDREN IN JAMAICA 18

Every attempt will be made to see that your study results are kept confidential. A copy of the

records from this study will be stored in a locked filing cabinet and a coded security system at

the Northern Caribbean University. A copy of the consent form will be put in your chart, and a

second will be kept at the Northern Caribbean University Nursing Department. The results of

this study may be published and/or presented at meetings without naming you as a subject.

Although your rights and privacy will be maintained, the research team and members of the

department particular to this research will have access to study records.

COMPENSATION FOR RESEARCH

The researcher will only pay for any injury or loss that has occurred while participating in the

study. No other treatment or loss of property outside of the study will be compensated.

FINANCIAL COST

All transportation costs will be subsidized by the researchers.

CONTACT FOR QUESTIONS

If you have any questions, problems, or research-related problems at any time, you may call the

Northern Caribbean University at the Nursing Department at 962-2862 for any questions you

may have about your rights as a research participant.

VOLUNTARY PARTICIPATION

Participation in this research is voluntary. You may refuse to participate at any time. If you

refuse to participate, the benefits to which you are otherwise entitled to will not be affected. You

may decline by calling Margret Marie Evans at 962-2454. You will be informed if any of the

results of the study will make you change your mind about being a participant of the study.
OBESITY AMONG CHILDREN IN JAMAICA 19

Signing below, confirms you agree with the terms and conditions of the study. You will be given

a signed copy of this informed consent document. You will be given the chance to clarify any

concerns about the study and to discuss your participation with the investigator.

You can freely and voluntarily choose to be in this research project.

PRINCIPAL INVESTIGATOR: ________________________________________________

_______________________________________________________DATE_______________

SINGNITURE OF VOLUNTEER DATE

____________________________________________________________________________

SIGNITURE OF PARENT/LEGAL GAURDIAN (if applicable) DATE

_____________________________________________________________________________

SIGNITURE OF WITNESS (if applicable)

OBESITY AMONG CHILDREN IN JAMAICA 20

Appendix C

Questionnaire

This questionnaire is about your child’s eating habits and physical activity. It consists of 12

questions along with their selections which should be answered by placing a tick in the boxes

provided for each of the questions. Your participation in this survey is voluntary and all answers

will be kept confidential. However, it is mandatory that all questions are answer appropriately.

We are hoping that the information we get in this survey will help us to understand more about

the factors which contribute to childhood obesity.

Thank you for your cooperation in completing this survey.

OBESITY AMONG CHILDREN IN JAMAICA 21

Questionnaire

Demographic information

Socioeconomic Status

Eg. 1. Your level of employment

Self employed [] Private [] Public [] Other ____________________

2. Level of Salary

$250 per week [] 500 per week [] 1000 per week [] other_________

Physical Activity

1. Do you think your child eats more while he or she is watching the television?

Yes

No

Not sure

2. What meal is given to your child on a typical day?

____________________________________________________________________

3. Do you think that food advertisements influence your food choices?

Yes
OBESITY AMONG CHILDREN IN JAMAICA 22

No

Maybe

If yes, state how

4. How often does your child participates in physical activities?

One to three times per week

More than three times per week

Never

5. Does your child snack between meals?

Yes

No

If yes; how often _______________________________

6. Does your child often sleep immediately after eating?

Yes
OBESITY AMONG CHILDREN IN JAMAICA 23

No

Sometimes

7. Do you reward your child with food?

Yes

No

Sometimes

8. Does your child eat fruits and vegetables daily?

Yes

No

Sometimes

9. How often does your family eat fast food?

Once per week

Two to three times per week

OBESITY AMONG CHILDREN IN JAMAICA 24

More than three times per week

10. Does your child play a role in food choices?

Yes

No

Sometimes

11. How would you describe your child’s weight?

Very underweight

Slightly underweight

About the right weight

Slightly overweight

Obese

12. In your opinion how important is your child’s food choice to his / her present health?
OBESITY AMONG CHILDREN IN JAMAICA 25

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________