Childhood Obesity EBR

Running Head: QUANTITATIVE RESEARCH ARTICLE ANALYSIS 1
Quantitative Research Article Analysis: A Policy-Based School Intervention to Prevent
Overweight and Obesity
Alexander G. Skomra
Roberts Wesleyan College

QUANTITATIVE RESEARCH ARTICLE ANALYSIS 2
Quantitative Research Article Analysis: A Policy-Based School Intervention to Prevent
Overweight and Obesity
Weight gain and obesity contribute to a multitude of health problems. More particularly,
concern of overweight prevalence throughout the nation has lead to an increase in active
prevention participation. The nursing practice provides treatment and prevention education,
along with support of evidence-based research, in effort to target the younger generation.
Knowing problems with weight can originate from a variety of factors early in life, much
research focuses to understand lifestyle modification in children. The purpose of this paper is to
critically evaluate the evidence presented in a research study by Foster, Sherman, Borradaile,
Grundy, Vander Veur, Nachmani, Kayrpyn, Kumanyika, and Shults (2008).
The Purpose and Problem
The problem identified by the researchers was the issue of the serious prevalence and
consequence of childhood obesity. It is assumed that a variety of factors can contribute to weight
gain in children, however the research is aimed specifically to evaluate how nutritional factors in
school can influence weight in students. Therefore, the purpose of the study was to examine the
effect of their defined multicomponent School Nutrition Policy Initiative (SNPI) on weight in
school-aged children. The flow of the article is difficult to fallow. The control group is easily
accessible by the intervention of the study, as the intervention was implemented at school. The
Philadelphia based research was conducted over 2 years time. The study allowed an ample
amount of time, therefore increased probability the SNPI impact particular measurement.
Furthermore, the authors’ are active and credible in the state of Pennsylvania, well verifying the
study feasible.

Research Question and Hypothesis
Further exploration of the article provides little concrete evidence into a clear research
question in the writing. Questions are not clearly expressed, but can be linked to the concepts and
propositions in the framework. Analysis of the study can conceptually form a question to the
effectiveness of interventions outside the traditional clinical setting. Traditionally, problems with
weight and obesity in children are dealt more often on an individual basis, much like a healthcare
intervention. However, a community-based approach the study uses for intervention is aimed to
tackle weight problems in school-aged children on a broader scale. While the authors’ purpose is
to examine the effectiveness of community-based intervention, the correlation of the
multicomponent School Nutrition Policy Intervention to the decreased incidence of overweight
and obesity is left to evaluate. To claim the intervention productive in school-based
environments, it must decrease rates using its multi-faceted approach. Moreover, it must be
understood each approach uniquely is significant in defining the SNPI as a whole.
Difficult to decipher, the research question is aimed to prove a relationship of school-
based intervention with a decrease incidence of weight problems in children. The purpose of the
study draws a potential hypothesis: The positive effectiveness of a multicomponent SNPI in
relation to weight problems in children. School-based programs have not had favorable effects in
the past. Therefore, the research is set to prove otherwise. “Measurements were collected at
baseline in the spring semester and again at year 2 in the spring semester” (Foster et al. 2008).
Considered a pre-post two group experimental study, the quantitative measurements were taken
before intervention, as well as after two years time, to evaluate outcome.

Study Variables
In this particular research study, the independent variable was the multicomponent
School Nutrition Policy Initiative. The five components of the SNPI were labeled school self-
assessment, nutrition education, nutrition policy, social marketing, and parent outreach. All
subsets of SNPI intervention were used in establishment of the outcome, or dependent variable.
Measurable weight and height, dietary intake, physical activity, and sedentary behaviors were all
considered dependent. In the study, each variable was easily identified, in addition to the
characteristics of participants that were apparent in Table 1, on page 797 of the article.
Theoretical Framework and Review of Literature
The theoretical framework can be extrapolated from the article, so long as the reader is
capable of understanding the style of intervention. It is difficult to extract a precise structure.
However, the framing is established with a policy-based interventional approach. It is used
potentially to address the problems within the school system. More specifically, implementation
of a nutrition policy to certain randomized schools established and measured student outcome.
Collectively, the subsets of self-assessment, nursing education, nutrition policy, social
marketing, and parent outreach all were used to indirectly influence weights in school aged
children. Furthermore, the results were categorized into primary or secondary outcomes,
dependent on baseline measurement changes.
The review of the literature is organized at the beginning of the article. The authors
assume an understanding of childhood weight problems needing a solution. “Children spend half
of their waking hours in school” (Foster et al. 2008, p. ) Simply stated, the concept is distinctly
identified. School-aged children are the foundation of the study. Furthermore, according to the
“Handbook of Obesity Prevention, A Resource for Health Professionals” (2008) schools are

ideal settings for a population-based intervention to address obesity as a problem. Therefore, the
awareness to child lifestyle acts to funnel a justifiable reason for the initiative for the school-
based SNPI. Previous school-based attempts are recognized with some not effectively altered
BMI levels. Also, Doak et al. notes few studies have examined the effects of obesity programs
(2006). The cited literature effectively supports that SNPI is a viable intervention and should be
studied.
Nursing practice understands a prevention initiative for weight gain in school-aged
children to be more then an individualized nutritional or lifestyle change. The methods to prevent
overweight and obese school-aged children are multi-dimensional. Environmental influences
outside the traditional care plan implemented by a nursing provider can serve to effectively
prevent weight gain in children and significantly help in reducing BMI. Therefore, the researches
are consistent with a nurses care plan for preventing school-aged weight gain. The research does
so by modifying the nutritional intake in the school setting. The SNPI is considered
unconventional, however a valid method to primarily prevent weight gain.
Methodology
The design of the article elicits an understanding that the particular research is defined as
quantitative in style. More specifically, the experimental methods that form the study are
apparent with defined variables in the writing by the researchers. The study is true experimental,
as it is testing the multi-dimensional SNPI on the effects of overweight and obesity in school-
aged children. Random, cluster sampling is used to improve validity of the subjects tested???.
Manipulation is evident to test the effects of the intervention. The methodology is appropriate for
the study. The intervention is school based, targeting the weight problems in the student body
from a broad method of involvement.

Sample and Setting
Inclusion and exclusion criteria for the sample of the study were not blatantly apparent in
the article. However, conceptually, while understanding the method used by the research for
sampling, the experiment aims to select interventional schools that only fit a certain category.
Assumptions that correlate low-economic status to poor nutritional intake are the basis for
inclusion criteria in the researches. The authors used an accessible population from which to
conveniently select schools to invite into the study. The inclusion criterion is made certain, as the
research only allows eligible schools to be tested. The SNPI only intervenes on the systems
selected in the School District of Philadelphia. More specifically, those schools systems selected
have more then 50% of the students eligible for free and reduced priced meals. The exclusion
criterion is difficult to conceptualize. However, schools outside the chosen parameters were not
selected to participate in the study.
The measurable results particularly came from the sample of school-aged children,
however the schools each child attended were clustered in the study. “Schools were the unit of
randomization and intervention” (Foster et al. 2008, p. 495). In regards to how the students were
chosen, the researchers began by determining the eligibility of each school to participate,
providing they met the inclusion criterion. Next, the cluster sampling method allowed a sub-
grouping of these schools, yet again, based on similar school size and services offered. Lastly, a
pair of schools was randomly approached in each sub-group by researchers. Each was asked to
participate. After agreeing, the schools were only then randomly assigned as a control or
intervention group as a whole.
The sample size seems efficient in determining an accurate result for the study. “The
participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-

Atlantic Region” (Foster et al. 2008, p 495). At baseline, approximately 600 of the school-aged
students were randomly selected for the control group, 312 of them female. In addition, 749
students were selected for intervention, 412 of them being female. The average age of all
students was around 11 years old. In regards to race and ethnicity, statistics varied with both the
control and intervention groups. In the control group, the final composition was 46.8% Black,
27.7% Asian, 5.8% Hispanic, 5.5 % Other, and 14% White. Furthermore, the final ethnic
composition of the intervention group was 44.3% Black, 17.1% Asian, 22.4% Hispanic, 5.5%
Other, and 10.7% White. In addition, the analysis of baseline characteristics of each participant
reveals varying weight status percentages. Further analysis of the research reveals that around
50% of the children for both groups were considered of normal weight at baseline. However,
“more then 40% were overweight or obese, and nearly a quarter were obese”(Foster et al. 2008,
p 798). Additional characteristics of the sample that the researches took into account and
averaged included: Energy, Fat, Activity, Inactivity, Television per day, and Body
dissatisfaction. The mean BMI for all participants was 20.9 ± 5.1 km/m.
A power analysis could have been used to address the low representation. However, the
sample size seems to be effective in effort to detect truly the results of the intervention. The
criteria used, while the study is feasible because a substantial amount of characteristics in the
population can be measured after the intervention takes place. To broaden the study outside the
boundaries of Philadelphia could deem the study more indicative of the effectiveness of the
intervention, however. After all, the larger the sample size, the more valid the results.
A large amount of bias in the sample is not clear. If any, it seems biasness exists to
examine the children within an urban public school systems. Socioeconomic status is targeted by
the research. The ethnicity percentages seen in the baseline participant characteristics outline

seemed to correlate with an assumed lower status population. To pick, specifically, a cohort of
school-aged kids with a higher risk of nutritional problems to prove the SNPI effective is the
basis for the study, however. Attrition rates of the sample were identified in the research article
by the authors to not differ between the control or intervention group. Student transfers, repeated
absences, and refusals were all contributing factors that were accounted for in the analysis after
two years time. “The analysis that accounted for attrition did not differ from the analyses using
complete data” (Foster et al. 2008, p 798). The outcomes were established by return visits, which
accounted for the absent students.
In further regards to the sample, written parental consent and child agreement were
acquired for the children to participate. “The consent rate across the 10 schools was 69.5% ±
15.4%” (Foster et al. 2008). This consent seems to be informed, where the researchers, in
writing, were able to get permission. In addition, the study was reviewed and approved by the
University of Pennsylvania Institutional Review Board.
The SNPI approached school-aged children with an angled tactic. The setting of the
multicomponent intervention was not limited to school campus. School dining halls, kitchens,
and classrooms, although they were settings of focus for SNPI, were combined with a “home-
base” approach. By implementing parent teaching, the family outreach component of the SNPI
was essential in bringing the setting of the intervention to the homes of the children. The
umbrella style approach was certainly appropriate in testing the effect of the intervention.
Measurements and Data Collection
Separate instruments of evaluation were used in the research to obtain outcomes.
Information was recorded at baseline and after the two-year allotment. Height and weight were

recorded at baseline, then annually for two total years. This objective information was paired
with analysis of information self-reports obtained. The combination of each used as data for
analysis. Self-style reports of race and ethnicity were used to analyze interaction effects of
overweight and obesity prevalence with the NSPI. Likewise, other self-report questionnaires
were also used for both nutritional and activity evaluation.
A further analysis into the research reveals the foundation for the objective measurements
were numerical values. “Heights and weights were measured annually on a digital scale and
wall-mounted stadiometer by trained research team with a standardized protocol”(Foster et al.
2008, p 796). As related to level of measurement, the researchers use of the scaling system is
consistent with ratio form. The numeric values precisely represent the specific physical features
of the school-aged children before and after the intervention, specifically. The physiologic
measurement strategy is perfect for the purpose of the study. Conceptually, the instrument
demonstrates construct validity and can be assumed reliable because a trained research team
controlled them. However, the researchers did not mention the exact model of the scale or the
calibration of the instrument used.
The research used the Youth/Adolescent Questionnaire to measure information like
dietary intake, physical activity, and the sedentary behavior in the school-aged students. “Dietary
intake, specifically total energy consumed (kilojoules), fat consumption (grams), and the number
of fruit and vegetable servings was measured with the Youth/Adolescent Questionnaire”(Foster
et al. 2008, p 796). In addition, two other questionnaires were used. First, the Youth/Adolescent
Activity Questionnaire measured physical activity and sedentary behaviors. The second was
named the Eating Disorder Inventory-2 and was used to collect data on body image
dissatisfaction. All of the questionnaires served as the self-report strategies for the study. The

methods were acceptable for the purposes of data collection. However, the reliability of each
questionnaire is left to interrogate, as any external influence was not clearly defined. The level of
measurement for each survey was not stated, nor did the writing speak directly to the specifics
related to reliability and validity. However, the validity of each questionnaire is congruent with
understanding each was utilized in previous reputable studies.
The process of data collection was clearly stated in the research. The researchers explain
how the data was uniquely pulled. However, the methods were vague as the researchers left out
certain information. Failure to address if the children were pulled from class, or how much time
it took to fill out each questionnaire leaves discrepancy. Moreover, each funneled data uniquely
into a set of information that was analyzed. The numeric levels of height and weight were used in
the research to form values. “BMI z scores and percentiles based on age and gender were
calculated for each student using CDC growth charts” (Foster et al. 2008, p 796). By the use of
assigned values, each participant was classified further into four categories labeled underweight,
normal weight, overweight, and obese based on BMI. Additional data from each questionnaire
was used to establish secondary outcomes. Understandably, most of the data came from the
largest survey, approximating 152 questions. All collection methods seemed to be ethical.
Furthermore, although not very clear, the collection conceptually was consistent and well formed
manor. The instrumentation was not harmful to the participants and all methods were used only
with established consent.
Statistical Analysis and Results
The statistical analysis is complex. An in-depth look at the information reveals that
information was collected and categorized. Additionally, all data was gathered to reach primary
and secondary outcomes. The direct measurements of overweight and obesity were labeled

primary. BMI scoring, along with data that was collected by the self-report questionnaires, were
considered to be secondary outcomes. Data was consolidated using the generalized estimating
equations method (GEE) in order to model binary outcome for both primary and secondary
results. In addition, count variables were produced by the Poisson distribution, created by the
GEE. The researches analyzed the mean of data gathered baseline and at the end of two years.
Furthermore, they accounted for attrition by using the multiple imputation procedure (MI) to
input any missing data. The MIANALYZE procedure allowed data to input into a single set. The
researchers seemed to use each procedure appropriately to stratify data that created the results.
Tables exist in the body of the research to summarize and agree with the texts description of the
statistical analysis. The measurements of prevalence, incidence, and remission in both the control
and intervention groups are well defined in Table 2.
The results of the study were sectioned. The first compiled a discussion of student and
teacher participation. Out of those who participated “the consent rate across the 10 schools was
69.5% ± 15.4 %, with no difference between control and intervention schools.” In addition, data
yielded a total of 1349 students assessed at baseline. A total of 68% were reassessed after a
year’s time and 63% were assessed after two years, respectively. The research continues
discussion of the results with sections dedicated to baseline characteristics, as well as divisions
of primary and secondary results.
The primary outcome section conceptualized the fact that significantly fewer children
became overweight in the intervention schools after two years, as compared to the control. In this
section, it seems to depict the SNPI successful. “The implementation of the multicomponent
SNPI was associated with a substantial (~50%) and statistically significant decease in the
incidence of overweight” (Foster et al. 2008, p 800). Moreover, the odds of incidence were also

lower after collapsing the overweight and obese weight categories. In addition, the results
depicted the prevalence of overweight in school-aged children to be overall ~33% lower in the
intervention group. Specifically, overweight prevalence increased by 25% in the control schools
after the SNPI with a decreased by 10.3% in the intervention schools. “In addition to the main
effect of the interventions, the interventions effect on the prevalence of overweight and obesity
was particularly effective for black students” (Foster et al. 2008, p 799). In particular, results of
prevalence indicated the African American students were the most affected of all other ethnic
groups studied.
In terms of remission, there was no general affect to either control or intervention group.
Also, the results depicted that inactivity slightly decreased with the intervention group as result
of the NSPI. “After controlling for gender, race/ethnicity, age, and baseline inactivity, inactivity
was 4% lower in the intervention group then the control group”(Foster et al. 2008, p 799). Lastly,
the study stated the SNPI had a minimal change to body image the school children.
In effort to summarize the results, data suggests that the SNPI can be considered an
effective means to curb the development of obesity in school-aged children. However, more
interventions may be needed. “A troubling observation within these data are that, in the absence
of any intervention, 15% of children who were not overweight in grades 4 to 6 became
overweight over the next two years”(Foster et al. 2008, p 801). The research conclusions unveil
many possibilities for future indications in weight management in schools. All things to consider,
a more consistent intervention at a much longer increment might be needed. In addition, maybe
even an increased amount of schools participating and perhaps an even younger target age!
Strengths, Limitations, and Conclusion

The strength of the study is based on a thorough analysis of the multicomponent SNPI.
The implication of the intervention from a few different approaches is a powerful strategy to
pinpointing specific effects on weight gain and obesity in school-aged children. The research was
clear with its purpose, aim, and hypothesis. Furthermore, the relevance of the overweight and
obesity study to the school-aged children is high, where only few efforts to intervene at a school-
based level for analysis of this topic have been implemented. The research thoroughly describes
each component of the intervention, as well as specifically identifying the target population
involved. Additionally, the successful pre-post test study is used to effectively measure objective
and subjective information. However, particulars are left to question. The exact methods
instrumentation and measurement in the study are not specifically discussed.
A power analysis could have been used for the study to elicit a better sample for the
study. The relevancy of the population sample of a lower economic status is solid, especially
when related to the purpose of the study. However, the population was still only limited to the
greater Philadelphia area. Furthermore, the school-aged children influenced by the intervention
were only attending the schools with greater then 50% of its students eligible for free and
reduced meals. The limitations depict the validity of the study to only vaguely pertain to those
students with similar criteria.
Furthermore, the method of data collection could have been more specific. Objective and
subjective measurements were products only methods that were briefly described. The specificity
of the each self-survey could have been addressed more-so to identify potential bias in the
answering process. The research raises questions to whether gaps exist between each
participant’s honesty while answering the surveys. Regarding the discussion pertaining to

outcome in the research, the tables correlated well with the breakdown of measurements into
data brackets.
The findings of the study are linked appropriately to the study framework. The
measurements established outcomes thoroughly, which lead to results well depicted at the end of
the research. The results reported decreases in overweight and obesity in the interventional
schools in association with the SNPI accurately. Elaboration of the positive effects on the overall
prevalence of obesity are also explained, even more-so intently as related to the African
American students in the study. Despite the discrepancies of the research methods and
instrumentations, the research positively and clearly identifies the general effectiveness of the
intervention in the discussion at the end of the article.
The research concludes based on its findings that trends exist affecting the nations’
school-aged population. Discussion identifies that after two years, millions of children will
become overweight and obese. Additionally, is recommends an improvement to any intervention
that is similar to the one used in the study. Conclusions endorse a focus to other aspects of the
school-based environment for intervention, as well. Lastly, prevention programs should be
started earlier then fourth grade. The study could be replicated at a later date to confirm results.

References
Doak, C.M. , Visscher, T.L.S., Renders, C.M., & Seidell, J.C. (2006). The prevention of
overweight and obesity in children and adolescents: A review of interventions and
programs. Obes. Rev. ;7(1):111-136
Ford, E.G., Vander Veur, S. S., & Foster, G.D., Obesity prevention in school group child care
settings. In Kumanyiki S., Brownson R. C., eds. Handbook of Obesity Prevention. A
Resource for Health Professionals. New York, NY: Springer; 2008; In press
Foster, G. D., Sherman, S., Borradaile, K. E., Grundy, K. M., Vander Veur, S. S., Nachmani, J.,
Karpyn, A., Kumanyika, S., & Shults, J. (2008). A policy-based school intervention to
prevent overweight and obesity. Pediatrics: Official Journal of the American Academy of
Pediatrics, 121(4), 794-802. doi: 10.1542/peds.2007-1365

Childhood Obesity EBR

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