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American Academy of Pediatrics. n.d. Web. 08 Oct. 2016.

The website for the American Academy of Pediatrics (AAP) is a hub for pediatric
information, providing studies published in pediatric journals, pages dedicated to pediatric
trainees, and links to professional resources. The main sections on the homepage are links to
articles, AAP resources (for example, Zika response and testing information), and information on
current health topics. The Professional Resources page gives links to different journals,
publications, and research related to the field of pediatrics. It even provides resources for people
interested in pursuing the pediatric profession. The AAP website also includes a page describing
the Academy, as well as the local chapters and districts. There is legislation and certain policies
that the AAP advocates for, which are also detailed on their webpage.

I will be able to use this website to my advantage in many ways. The AAP homepage
includes multiple different articles published about past studies or current health issues, and a
wider range of articles are linked from their Professional Resources page. Because I am still
narrowing down my topic, the numerous articles directed from the AAP website will help me to
read about past research and learn more about what has been done in this field. The AAP website
also provides many resources and lots of information about pursuing a career in pediatrics, which
I am . Because of my interest in this field, I can also explore more about the different types of job
within this field and what to expect.

Birch, L.L., PhD & Fisher, J.O., PhD. (1998). Development of Eating Behaviors Among
Children and Adolescents. Pediatrics, 101(2). 539-549.

This article published in the official journal of the American Academy of Pediatrics
investigated the relationship between obesity in children and their eating habits influenced by
their parents. Previous research has suggested an increased likelihood of obesity in children
whose parents are also obese, as well as possible genetic predispositions. However, this study
aims to distinguish between these genetic factors and the environment. Children learn a lot about
food and eating habits between the transition of an exclusive milk diet and an omnivorous diet.
Factors such as gender, parental control, self-regulation, and television also greatly impact a
childs development of eating habits. The authors of this article found that while environments
can create susceptibility to obesity, these results cannot be faithfully applied across
socioeconomic and racial backgrounds.

While I am still narrowing down my research topic, I would like to focus on nutrition
issues relating to children and adolescents. Obesity is a large epidemic that is growing
throughout the American population, so I am currently reading previous research on this topic.
This particular article is helpful because it illustrates certain patterns between eating habits and
parts of everyday life, which can then be drawn back to the current obesity epidemic. For me, the
article was very helpful because it provided me with background information on obesity and
research conducted in this area. While it is not a very recent article, it still gives me a basic
overview.

Center for Disease Control and Prevention. (2010). Childhood Obesity. Retrieved from
http://www.cdc.gov/HealthyYouth/obesity/
This Center for Disease Control and Prevention (CDC) page states many facts related to
childhood obesity. It defines obesity as excess body fat, which is a result of caloric imbalance.
This means that there are too few calories expended for the amount of calories consumed, but
obesity can also be affected by certain genetic, behavioral, and environmental factors.

This page will be really important in building my claim, since it provides a lot of logos.
The CDC is also a very credible source, since it is a government agency, so the information from
this website also carries ethos. These two modes of persuasion will strengthen my claim and help
organize my thoughts. Tables and maps are also included in this website, so it gives me a
different perspective and a way to visualize the data explained above. In general, the statistics
cover different parts of pediatric obesity, so I can use them throughout my paper.

Dietz, W.H., Gortmaker, S.L. (2001). Preventing obesity in children and adolescents. Journal of
Public Health, 22. 337-353.

This article discusses the prevention of obesity in children, specifically in family-based


and school-based prevention. Researchers discussed the energy balance for the child between
these two types of intervention. They explained the energy intake and output of the child, and
how that might affect treatment. An example given was television viewing. When a child
watches television, they are both expending and taking in energy, so that would be an optimal
time for intervention.

For my third control, I want to discuss and propose solutions for pediatric obesity, and
this source will be helpful in that aspect. The article will be able to guide me in possibly creating
a similar intervention program, but some of the concepts introduced were confusing. The idea of
energy intake and expenditure made sense to me, but I didnt see the meaning behind its role in
intervention. I plan to use this source for my third control, specifically the parts of the article that
I agreed with.

Ebbeling, C.B., Pawlak, D.B., & Ludwig, D.S. Childhood obesity: public-health crisis, common
sense cure (2002) Lancet, 360. 473-482.

Because of the rising international fame of pediatric obesity, this article explains and
gives background information on childhood obesity. It has been rapidly increasing, although
doctors and researchers cannot pin down one final definition for obesity. This also contribute to
the difficulty of researching obesitys prevalence. It can be caused by genetics or environment of
the individual and has some very adverse affects on the childs future health and mental health.
This article also proposes possible solutions and prevention techniques to childhood obesity,
such as school-based intervention or pharmacological treatments.

This study was a good start to my research into pediatric obesity since it was purely
informative. It was extremely helpful to have a strong foundation in the topic I want to study and
this article provided helpful insight to the factors of pediatric obesity. This will be helpful to me,
especially because I just started this new topic and need some background information. I dont
think Ill use this source explicitly in my paper, but it has definitely helped me gain a better
understanding of pediatric obesity.

Erol, R. Y., & Orth, U. (2011). Self-Esteem Development From Age 14 to 30 Years: A
Longitudinal Study. Journal of Personality and Social Psychology, 101(3), 607-619.

This study details the findings and results of a study conducted to record the development
of self-esteem from ages 14 to 30. The authors first introduce the topic of self-esteem and the
factors that have an influence on it. These influences include gender, ethnicity, risk taking,
health, and sense of mastery, among others. The authors of this study, with information from
previous studies, hypothesized that levels of self-esteem would continuously increase during
adolescence and young adulthood. To assess the influences on self-esteem (risk taking, health,
sense of mastery, etc.), participants were asked questions and completed surveys. The results of
the data showed that self-esteem levels did in fact rise steadily, following most closely a cubic
model. The data assembled from results found from the different influences, however, varied
more. Levels of risk taking decrease as age increases, but the sense of mastery increases. All in
all, the results demonstrate that levels of self-esteem are higher in emotionally stable,
extraverted, and conscientious individuals, despite the ages studied. Furthermore, high levels of
self-esteem were present when there was a high sense of mastery, low levels of risk taking, and
better health.

I had chosen this study because I was thinking of connecting obesity with low self-esteem
and investigating its effects on adolescents. However, the article does not detail any information
about obesity and instead just discusses self-esteem. And, writing this in retrospect, I have also
decided not to pursue this aspect of pediatric obesity because I was more interested in the causes
of obesity, and not so much its effects. I think the pattern between socioeconomic status and the
prevalence of obesity is really interesting, and I would prefer to delve into that relationship.

Frankelstein, E.A., Trogdon, J.G., Cohen, J.W., Dietz, W. (2009). Annual medical spending
attributable to obesity: Payer-and service-specific estimates. Health Affairs, 28(5), 822-
831.

This article considers the estimated medical costs from patients with problems relating to
obesity. These costs were estimated to be up to $78.5 billion in 1998, but since then have
drastically increased. Because of the rise of this obesity, as well as all complications associated
with the disease, medical spending has also increased. In 2008, the annual medical spending
associated with obesity was estimated to be about $147 billion.

This article is made up of mostly statistics, so Ill be able to use these facts and findings
to boost my logos. This information would be with the effects of obesity, although I would like to
find another source to corroborate this one if I decide to make that one of my controls. With this
article, it only discusses medical costs for obesity in general, and I am researching pediatric
obesity. While the information would still apply, it wouldnt be as specific and would not directly
apply to my research topic.
Frost, J., & McKelvie, S. (2004). Self-Esteem and Body Satisfaction in Male and Female
Elementary School, High School, and University Students. Sex Roles, 51(1), 45-54.

This study researches the difference in self-esteem, body satisfaction, and body build
between genders and ages, specifically male and female elementary schoolers, high schoolers,
and university students. Their results showed that, overall, levels of self-esteem were highest in
male high school students. Low self-esteem levels positively correlated with body satisfaction,
which, in this study, were measured through cathexis, body image, and weight satisfaction.
Overall, self-esteem correlated with all three measures of body satisfaction, but only body image
and cathexis were significant predictors in the regression equation for all participants
combined. Nonetheless, body image was an average predictor of self-esteem, and the most
consistent predictor was cathexis. Weight satisfaction, on the other hand, was never a predictor,
but body image did have some impact on self-esteem levels.

Through this article, I was hoping to learn more about body satisfaction in adolescents. I
am thinking of writing about the harmful effects of obesity and unhealthy eating habits on mental
health, so I need to get background on how adolescents normally feel about their bodies. There
were interesting patterns in levels of self-esteem, and I would like to connect that with other
possible factors of obesity to investigate any correlation. While this article provided great
background information, it seems very familiar to my Independent Research project, so I dont
know if I would like to pursue this topic.

Golden, N.H., Schneider, M., & Wood, C. (2016) Preventing Obesity and Eating Disorders in
Adolescents. Pediatrics, 138(3). 138.

Some adults are concerned that through adolescent obesity prevention, we may be
unknowingly encouraging adolescents to engage in unhealthy eating habits, or even eating
disorders (EDs). While teenagers with EDs do not always have obesity, they may develop an ED
from an attempt to lose weight. This problem of unhealthy weight loss also stems from the lack
of focus on a healthy lifestyle, which can also be applied for the opposite meaning. Previous
research has found that children that continue to be obese throughout adulthood will have serious
health complications. Medical complications can also be a hazardous side effect of eating
disorders. Malnutrition and rapid weight loss as an adolescent can lead to numerous health issues
as an adult (hypothermia, orthostasis, etc.). One connection between obesity and eating disorders
lies in calorie intake. The Food and Drug Administration recommends a 2,000-calorie diet, but
active adolescents need at least 200 more calories for proper growth and development. When
teenagers try to eat healthier and cut our foods from their diet, they can end up falling short of
their minimum calorie requirement. This article goes on to say that overweight teenagers can be
more likely to develop disordered eating habits when trying to lose weight.

Another issue I am interested in researching is eating disorders, specifically for


adolescent girls. This article allowed me to read current literature about how EDs affect my
targeted age group, but it also relates to obesity and possible prevention side effects. I find this
helpful because it helps me to see the connection between the two, but also allows me to
compare and evaluate which topic I am more interested in.
Hendrickson, D., Smith, C., & Eikenberry, N. (2006). Fruit and vegetable access in four low-
income food deserts communities in Minnesota [Abstract]. Agriculture and Human
Values, 23(3), 371-383.

This study focused on accessibility to fresh fruits and vegetables by Minnesota residents
of lower socioeconomic status. Data were collected through group discussions, survey responses,
and store inventory. Different communities were evaluated: two urban and two rural areas were
selected. Through their data collection, the authors of this study found that in the urban
communities, a significant number of foods were much more expensive than the Thrifty Food
Plan (one of the United States Department of Agricultures food plans designed to ensure proper
nutrition) and even more so in the two rural communities. They were also able to narrow down
the major barriers of shopping to cost, quality of food, and a limit in options. For the last factor,
community members issued complaints in the studys group discussions that available, healthy
food was costly, of fair or poor quality, and limited in number and type available. Community
members reported that, in general, making healthy food choices was not within their budget,
causing people in their communities to suffer from food insecurity (defined by the United States
Department of Agriculture as a lack of access to affordable, nutritious food), thereby preventing
them from maintaining a healthy lifestyle.
The full article was not available online, but the abstract was very extensive and provided
extensive information on the struggles of creating a balanced and nutritious diet, specifically
from an average Americans point of view. The findings of this study only show that it is difficult
for low income families to purchase nutritious foods and sustain a healthy lifestyle, but it does
not explicitly mention obesity. This study also focused on four Minnesotan communities, which
is a very specific group of individuals, so the findings here might differ for others. This study
also highlighted the difficulty of access to food when living in a rural community, something I
had never considered before; previously, I was focusing my research on the inner city regions.

Holmes, L., Jr., LaHurd, A., Wasson, E., McClarin, L. Dabney, K. (2015). Racial and Ethnic
Heterogeneity in the Association Between Total Cholesterol and Pediatric Obesity.
International Journal of Environmental Research and Public Health, 13(19). 1-10.

This article researched the association between total cholesterol (TC) and race/ethnicity.
It has already been found that TC directly correlates to obesity, but researchers of this study
investigated the possible correlation between race and TC, national BMI percentile, and average
weight (within that race). Researchers assessed data of over 60,000 children from electronic
medical records between 2010 and 2011. Using data analysis techniques, researchers found that
there was a significant effect of race on cholesterol levels. Black/African American (AA)
children and children of some other race were more likely to have a higher BMI, and Asian
children had the lowest BMI. In general, Black/AA children had the highest BMI percentile,
likelihood of abnormal TC, and average weight. Asian children generally had the lowest BMI
percentile and average weight.

This study provides great information for the effect of race on obesity, but one of my
arguments discusses the effects of socioeconomic status. While past connections can be drawn
between the races and ethnicities that have suffered from poor socioeconomic status, this whole
study is not really helpful to my particular topic. Researchers also used data from 2010 through
2011. Doctors and scientists are constantly publishing new research, especially on the topic of
obesity, a rapidly rising disease were trying to learn more about. I am concerned about the fact
that this research might be outdated, but the findings of this study do not seem like they would be
easily overturned. I would like to keep this source as a backup because while it doesnt
appropriately apply to my topic, it is slightly relevant and may prove to be helpful in the future.

Inagami, S., MD, MPH, Cohen, D.A., Brown, A.F., Asch, S.M. (2009). Body Mass Index,
Neighborhood Fast Food and Restaurant Concentration, and Car Ownership. Journal of
Urban Health, 86(5). 683-695.

This study was conducted to look into the relationship between fast food and
concentrations of restaurants to body mass index (BMI) of the consumer population, as well as
whether car ownership regulates this association. Using 2000 US Census data and restaurant
information within Los Angeles County, researchers studied 63 neighborhoods and the residents
BMI, fast food and restaurant concentrations, and car ownerships. It was found that car owners
have higher BMIs in comparison to those without cars, but individuals who do not own cars and
reside in areas with a high concentration of fast food outlets have higher BMIs than non-car
owners who live in areas with no fast food outlets. These researchers were even able to find that
those without cars living in high concentration areas weight approximately 12 pounds more (for
someone with a height of 5 feet 5 inches). For those living in an area of higher restaurant
concentration, their body mass index is higher than other residents of Los Angeles County.
Researchers concluded that the local fast food environment is strongly related to the BMI of
locals who do not own cars.
While the results and conclusions of this study are very helpful, they mostly provide
background knowledge. Because of the specificity of the studied topic and since it is not very
similar to my topic, I do not think this article will be useful in writing my paper, but it did
provide further evidence that socioeconomic status will affect eating habits negatively, and
therefore play a role in obesity.

Kim, S., Willis, L.A., (2007). Talking about obesity: News framing of who is responsible for
causing and fixing the problem. Journal of Health Communication, 12. 359-376.
By analyzing newspapers and television, the authors investigated the causes and possible
solutions of a national epidemic: obesity. The authors found that these forms of media, also
including the individual himself, are all responsible for obesity. They write that the blame is
equally doled out to each category. As for fixing this problem, the authors observed an increasing
trend of societal solutions, rather than more specified individual solutions.

This article is helpful because it provides insight into some of the causes for obesity. It
references the different factors that can contribute to this disease, which I would like to write
about in my paper. I havent yet narrowed down which causes, but I think that this subtopic of
media is really interesting. In this modern age, so much of what we do is dominated by media
and I think it would be really interesting to explore that relationship with the obesity epidemic.
KinderMender Walk-in Pediatric Center. n.d. Web. 08 Oct. 2016.
The website for the KinderMender pediatric walk-in clinic provides extensive
information about the clinic. On the home page, they provide a short section explaining the
thought behind KinderMender, as well as an overview of services provided. The wait times at
each of the three locations are also posted. Because the doctors of KinderMender also act as
patients primary care physician, there are links to schedule appointments or download forms.
Some of the websites pages give a more detailed explanation of things mentioned on the
homepage, such as services provided or why parents should choose KinderMender. Other pages
discuss the staff of this clinic (which consist of doctors, medical assistants, business operations
staff, etc.), the Frequently Asked Questions, and informational videos. There is also the option to
translate the entire website to Spanish.

Because I am interning at KinderMender, this website will be especially helpful. Reading


and learning about the different services provided will prepare me for seeing them when I
actually go to the clinic. This will further enrich my learning experience by giving me a sense of
awareness.

Lundahl, A., & Nelson, T.D. (2016) Journal of Health Psychology. 21(6). 1055-1065.

Researchers and doctors have recently been observing a relationship between attention
deficit hyperactivity disorder (ADHD) and childhood obesity. However, the authors of this study
are investigating the role of sleep problems in this, and its potential effects on obesity. Sleep can
influence the biological, psychological, and social aspects of both ADHD and obesity.
Overlooking this vital relationship has some important implications in terms of treatment.
Disrupted sleep patterns in particular should be assessed regularly and, when treated correctly,
can improve ADHD symptoms and weight management.

I found this article while looking into outside effects on obesity, and while it does provide
an interesting new connection between ADHD, sleep, and obesity, it does not relate to my
research topic. I would like to focus more on socioeconomic and perhaps racial/ethnic effects, so
this article is not relevant to me.

Musgrove, C. (2007). Childhood obesity: the problem? The solution? British Nutrition
Foundation, 32. 406-411.

This is a report from a conference of the Royal Society of Medicine for which the topic
was childhood obesity. The speakers discussed the current work being done to reduce obesity
rates, but also bring the staggeringly dangerous trends to an end. Topics included obesity
awareness, healthy living tips for families, and future consulting workshops. Attendees even
debated whether or not pediatric obesity leads to detrimental future health problems. They also
examined NICE guidelines and ethics of childhood obesity screening programs.

Although this is a report of a British conference, I think it will be beneficial to see what
the rest of the world is doing to tackle this problem of childhood obesity. Sharing information
allows us to see what has worked and what hasnt. The presented topics may not necessarily
correspond to my research topic, but the discussions will be helpful in understanding the
background of the issue, but specifically what leaders are engaged in. This, however, brings up
the issue of date. This conference was held 9 years ago, so much could have changed between
that time. Although some of those debated topics back then might now be cemented in
confidence, this report will still help me to understand what people have been trying to do.

Okoye, N., CPNP. Personal interview. 07 Dec 2016.

Certified Pediatric Nurse Practitioner (CPNP) Nneka Okoye answered my questions


concerning pediatric obesity. Body Mass Index (BMI) is used to diagnose obesity. BMI is
calculated by dividing your weight (in kilograms) by your height squared (in meters). However,
there are some flaws in this diagnosing process. Okoye says that calculations for the ideal BMI
were based on caucasians, so that other races werent taken into consideration when establishing
the norms. I asked her whether the BMI was a misleading representation of a childs health, and
she said it could be deceptive and does not tell the whole story, but is a useful tool. Once a
child is diagnosed with obesity, Okoye recommends to the child and parent(s) that healthy
eating and [increasing] activity are key. Fast foods, soda, and foods with empty calories (candy,
chips, etc.) should be avoided and, if possible, eliminated from the diet. The patient should
increase intake of water and fresh fruits and vegetables. One way to change diet is to eat more
colorful foods, such as carrots, spinach, and berries, which are typically healthier, and avoid
white and brown foods, such as rice, pasta, and bread. To the parents, she advises eating out less
and cooking meals themselves; this allows you to see what goes into your food and ensure that it
is good for your health. When a child develops obesity, there are some other health problems that
are likely to appear. These include diabetes, hypertension, high cholesterol, and sleep apnea. In
terms of the relationship between puberty and weight gain/loss, Okoye noted that kids weight
will increase as their height increases, starting at puberty, but preteens and teenagers are more
concerned about their weight. In addition, Okoye pointed out that in neighborhoods with lower
socioeconomic statuses, unhealthy foods (fast food and fried food) are more readily available.
She mentioned the phrase food desert, which is an urban area that lacks access to fresh foods.
In more affluent communities, you see more farmers markets, organic markets, and stores such
as Whole Foods. It is more expensive to eat healthy foods, seeing as cherries cost more than a
bag of chips. Okoye concluded with the concept of socioeconomic status playing a large role
healthy eating and, consequently, obesity.
This interview was extremely helpful. I initially reached out to a few employees at
KinderMender, but some werent willing to answer my questions. I had six interview questions
regarding a background to obesity, such as diagnosing process and further actions one would
take. I was hoping to get some more background information on the diagnosing process from a
certified professional, since any other socioeconomic causes can be easily found in numerous
studies; however, Ms. Okoye went above and beyond in answering my questions! She mentioned
socioeconomic status and food deserts as a cause for obesity, which is basically my research
topic. I didnt mention those two topics in my questions, which shows that these are indeed two
major problems children are facing today. I was really happy and grateful with the amount of
information she gave me, since the background information gave me insight into the providers
point of view and since her additional information corresponded exactly with my research
project. This is really helpful to me, because it provides me with an outlook into how
professionals would actually diagnose and treat obesity, as well as recommendations that would
be given to a child affected.
Payne, L.O., Galloway, A.T., & Webb, R.M. (2011). Parental use of differential restrictive
feeding practices with siblings. International Journal of Pediatric Obesity, 6, 540-546.

This study investigated the effects of parental treatment of siblings on eating behaviors
and, as a result, obesity. Despite growing up the same household, biological siblings (the only
ones studied) are influenced by different parts of their environment and may also interact with
parents differently. Obesity is increasingly becoming a more common disease developed by
children, so researchers investigated the different restrictive feeding practices of parents with two
biological children. Restrictive feeding practices are are defined as the denial of food to a child;
for example, when parents dont give their kids energy-dense foods. Researchers used the
childrens BMI to compare their data, as well as a Child Feeding Questionnaire, filled out by the
parents. The questionnaire measures the parents attitudes about their childrens intake of food
and their current weight. These two factors were assessed and researchers found that concern for
a childs weight was a common indicator of restrictive feeding habits in parents. Parents were
more likely to use differential restrictive feeding habits (as in, feeding their children in different
ways) when they had differential concern for the weight of one child. However, this concern and
differential treatment had no actual effect on the childs BMI.

For one of my controls I was thinking of discussing some of the outside factors that
contribute to obesity and this study provides sound information to support my claim. While I do
not plan to go as in depth as this study, I think that the results and conclusions will prove to be
extremely helpful to me in the future. This studys findings on influence of parents on
development of eating habits also corroborates the findings of another article I had previously
read. Socioeconomic status is another influence of obesity that I am very interested in
researching. This study gave an example of restrictive feeding practices as a parent denying a
child access to energy-dense foods. Healthier foods, like fresh fruits and vegetables, are more
expensive and are harder to afford for low-income families. Although this topic is not explicitly
discussed in this article, this studys findings will allow me to strengthen my claim.

Pbert, L., PhD, Druker, MA, Barton, B. PhD, Schneider, K.L., PhD, Olendzki, B., MPH,
Gapinski, M.A., MSN, RN, NCSN, Kurtz, S., MS, & Osganian, S. MD, ScD. (2016)
Journal of School Health. 86(10). 699-708.

Because of the increasing epidemic of adolescent obesity, treatment models are needed
for implementing healthy weight management. The researchers of this study designed a school-
based treatment trial in which two groups (from 8 public high schools) were randomly assigned
to two different treatment plans. The control group took part in a 12-session cognitive-behavioral
counseling intervention with a school nurse. The experimental group took part in the same 12-
session intervention, but along with an after school exercise program. Participants that were
overweight completed self-assessments (for behavior and measurements) before the start of the
program, and again after eight months. However, researchers found that students in the
experimental group (compared to those in the control group) showed no difference in BMI,
percent of body fat, or waist circumference. They concluded that, while this program would work
in theory, it had not worked in real life. Interventions would likely only be sufficient if the social
norms and environment of the individual were changed.
I would like one of my controls for my paper to focus on certain solutions and treatments
we can employ to alleviate this obesity epidemic, and I think this article will be especially
helpful in perhaps designing my own program. It discusses and outlines a school treatment
program for obese adolescents, which aligns with what I would like to write about. It shows just
one type of treatment, but there are many other solutions that could work, and perhaps be even
more effective. And although the results from this study showed that this treatment did not work,
I could still use this source as a guide and jumping point.

Rafei, Keyvan, M.D. Personal interview. 08 Oct 2016.

Dr. Keyvan Rafei is the founder and Medical Director of the KinderMender Pediatric
Walk-in Center. He first received his MD degree from the Medical College of Pennsylvania in
1996, but also received a Bachelor of Science in physics from Pennsylvania State University. In
2000, Dr. Rafei completed his pediatric residency training at the Baylor College of Medicine
Affiliated Hospitals. He is best known for his research on pediatric asthma, specifically care and
prevention. Dr. Rafei has been published in many different pediatric journals, and has spoken at
many national and international conferences.

Reed, M., PhD, RN, Cygan, H. DNP, RN. Lui, K., MD, Mullen, M., MS, RDN. (2016)
Identification, Prevention, and Management of Childhood Overweight and Obesity in a
Pediatric Primary Care Center. Clinical Pediatrics. 55(9). 860-866.

Because of the adolescent obesity epidemic, researchers of this study wanted to examine
primary care provider (PCP) adherence to American Academy of Pediatrics guidelines and
compare the treatment between patients of different weight classification, age, race, and gender.
Researchers targeted a random sample of 175 charts of six- to nine-year-olds seen for their well
visits. Data was collected through a feedback quality improvement project for that population.
Frequency of PCP adherence was recorded, and an analysis of weight classification, age, race, or
gender influence was conducted. To conclude, researchers identified five key areas for
improvement: diagnosis based on BMI, parental history of obesity, sleep assessment, endocrine
assessment, and attendance of patients at the follow-up visit.

This article did not have much relevance to my topic. It mainly discussed PCP adherence
to rules set out by the American Academy of Pediatrics and any possible difference in treatment
based on any factors. This is not related to what I would like to research this year. However, this
article did include some small facts that I could use to create a stronger claim. It discussed racial
and gender disparities in the prevalence of obese children, which I am planning to discuss in one
of my controls. As a whole, this article will not be very useful to me, aside from some small
details.

Rossen, L.M. (2014). Neighbourhood economic deprivation explains racial/ethnic disparities in


overweight and obesity among children and adolescents in the USA. Journal of
Epidemiology and Community Health, 68. 123-129.

This analysis investigated the effects of socioeconomic and racial/ethnic status on obesity
in adolescents. The author, Lauren Rossen, applied multilevel logistic regression models to data
from the National Health and Nutrition Examination Survey, specifically to examine the
frequency between obesity and race and socioeconomic background. The participants targeted
were children and adolescents between the ages of two and eighteen years that were linked to
census tract-level socioeconomic traits. Rossen found that among minorities such as black and
Mexican-American children, obesity was much more prevalent.

While this analysis provides great information, the results were not as helpful as I
expected. It will be a great source to support my claims, but some of the results dont relate to
my topic. I want to cite Rossens research when I discuss the socioeconomic effects on childhood
obesity, but her data set might be considered outdated. The results from the National Health and
Nutrition Examination Survey were taken from between 2001 and 2010. There is new research
being conducted and published each year, so some of Rossens data or findings could have been
disproven or even built upon. For this reason, I will not be using this source as a large part of my
research. (However, Rossen included many statistics and data in her findings, so as I find more
sources, I can refer back to this particular results section.)

Rubin, V. MCP, PhD, Bell, J., MPA, Mora, G., MPH, Hagan, E., MBA, PhD, Karpyn, A., PhD.
(2013). Access to Healthy Food and Why It Matters: A Review of the Research. Retrieved
from www.thefoodtrust.org.

This article is a joint report coordinated by PolicyLink and The Food Trust. It investigates
the accessibility of healthy foods as America moves out of the Great Recession and looks into
possible implications for future policy and research. Findings were compiled from a review of
previous literature on the subject; the authors of this study were able to find three main
implications of accessibility, or lack thereof, to healthy food: accessing food is a challenge for
families in low income neighborhoods and rural areas; living closer to healthy food is associated
with better eating habits, as well as decreased risk for obesity and diet-related diseases; and
healthy food retail stimulates economic movement. Starting with the patterns of urban sprawl
in the 1960s and 1970s (when affluent families emigrate from inner cities to the suburbs),
supermarket stores and chains had moved, leaving many inner city neighborhoods with few or
no full-service markets. Citing an national cross-sectional study, it was found that low-income,
urban neighborhoods of color have the least availability of grocery stores and supermarkets
compared with both low- and high-income white communities. Therefore, socioeconomic
status, along with race, play a large role in accessibility to quality foods and, accordingly, obesity
rates. Rural communities are also disadvantaged in terms of access to grocery stores,
supermarkets, or other food outlets. One specific community affected are those living on Native
American reservations; a study cited in this article found that 22 Native American reservations
had physical and financial obstacles to buy healthy foods. Transportation, mainly the lack thereof
and school settings also play large roles in accessibility to healthy foods.
As with the Hendrickson study, this article looks into the effects of food accessibility on
rural communities, which was not something I had previously considered, and seeing that this
issue plagues not just inner cities really intrigues me. Before, I had only thought of the suburban
supermarkets that were originally in inner cities, but I didnt research the difficult accessibility of
rural communities as well. The authors specifically mention Native American reservations.
Treatment of Native Americans is an issue I feel very strongly about, but I had never placed it in
relation to the topic Im studying now. Seeing this in two studies really intrigues me and I want
to consider altering my thesis to include this. Another advantage of this article is the recent
publication date; other literature I had read were mainly from the early 2000s, but because of the
relatively new topic of food deserts (one of my controls) many new discoveries or concepts can
become apparent. The article also explicitly discusses food deserts, a main part of my controls, as
well as considering the implications of socioeconomic status on rates of obesity in children.

Ruelas, V., L.C.S.W. Peters, Kipke, M.D., Ph.D., Iverson, M., M.P.H., Moore, D., M.A., Booker,
C., M.P.H., A.N., M.D., Kaufman, F., M.D. (2007). Food and Park Environments:
Neighborhood-level Risks for Childhood Obesity in East Los Angeles. Journal of
Adolescent Health, 40(4), 352-333.

The increasing rates of pediatric obesity have previously been attributed to poor nutrition
and lack of physical activity; however, the authors of this study investigated environmental
factors as influences on increased risk for obesity, specifically neighborhood-level
characteristics. East Los Angeles was chosen as the study community, because it has one of the
highest rates of childhood obesity in Los Angeles. Their data were collected by looking at the
relationship between the number/location of food stores to the location of schools; the
availability and quality of fresh foods at local stores; and the quality and usage of local parks.
Authors of this study found that 49% of the food establishments in the study community were
fast food restaurants and 63% of those fast-food restaurants were within walking distance of a
school. They also observed that only 18% of grocery stores sold fresh, quality fruits and
vegetables, and many werent within walking distance of a school. The parks of East Los
Angeles were found to be well maintained, but only accounted for 0.543 acres per 1,000
residents.
This study studied a very specific population, namely those living in East Los Angeles.
Obviously, because of this small population the findings of the study cannot be explicitly applied
to all areas of America, but it still has much evidence to support my claim, as well as providing
great background on the topic of the effect of environmental factors on pediatric obesity. I found
this article originally on ScienceDirect, but they did not provide full access to the text. I did
further searching using the title of the study and found the full text on the Journal of Adolescent
Health website, but it was very short. The full text included abstract, methods, results, and
conclusions, but there were only three to five sentences for each section. I am not sure if this is
indeed the full text of the study, but the concise information provided still proved useful in my
preliminary research.

Santos, M., PhD, Cadieux, A., PsyD, Gray, J., PhD, Ward, W., PhD. (2015). Pediatric Obesity in
Early Childhood: A Physician Screening Tool. Clinical Pediatrics, 55(4), 356-362.

Pediatricians and health care providers should have reliable tools in assessing obesity,
allowing them to then appropriately refer families to more specified aid. This can lead to weight
management treatment for children already diagnosed with obesity, and can help them healthily
and sustainably manage their weight. The authors of this article created a one-page screening tool
to be used in assessing children for obesity. It was created through research, previous clinical
experience, and consensus opinion, and designed to be used during routine doctor visits for
diagnosis and management of obesity. The handout starts with many different prompts, such as
Child behavior is impacting change in health behavior or Food aversion, oral aversion, picky
eating. These prompts then lead to actions, mostly referrals to different specialists like
psychologists and dieticians.

An issue I want to discuss in my paper is future prevention of obesity. In order to address


and treat the issue, its important to first define what the issue is. The handout from this article
creates a baseline for the provider to efficiently and correctly diagnose and treat their patient. I
would really like to include this idea in my paper, or at least use the researchers reasoning to
perhaps craft my own proposal. The past few sources Ive found havent been too old, but could
be considered outdated. This article, however, is very recent, so the information will be relevant.

Siskind, J., Galvez, M.P., Morland, K., Raines, C., Kobil, J., Godbold, J., Brenner, B. (2007).
Race and food store availability in an inner-city neighbourhood. Public Health Nutrition,
11(6), 624-631.

This study was spurred by previous research that showed the disparities in resources were
most common in minority neighborhoods, which were the same neighborhoods that had
increased risk for obesity and diabetes. Therefore, the objective of this study was to examine
whether populations of either 75% African American (AA) or 75% Latino had any relation to
their access to food stores, specifically compared to racially mixed population of East Harlem,
New York. Data were collected by a cross-sectional study that used a walking survey of East
Harlem. It was found that, out of all neighborhoods with at least 75% AA populations, none of
them had grocery stores or supermarkets. They were more likely to have convenience stores
compared with racially mixed neighborhoods. Conversely, Latino communities were more likely
to have convenience stores, specialty food stores, and fast-food restaurants when compared to
racially mixed neighborhoods. The conclusions of this study established that inequalities of
access to food stores exist by race and ethnicity in East Harlem, New York, meaning that there
are strong implications as to racial and ethnic differences in dietary quality, obesity, and obesity-
related disorders.
Again, as with some other studies I have read, the study group is a very specific population in
one city or town. This means that I cannot apply the results and conclusions directly to all
populations in America, but it still provides identification for important patterns in obesity and its
influences from socioeconomic status, as well as how that ties in with race or ethnicity. In this
way, this study helps solidify the claims Ive made in my thesis and will help strengthen my
argument synthesis paper.

Socioeconomics and Obesity. (2012, July). Retrieved from www.stateofobesity.org.

This webpage lists evidence supporting the relationship between socioeconomic status
and obesity. The whole page is dedicated to statistics and research that lead to the conclusion that
individuals with lower income and/or education levels are more likely to become obese. About
33% of adults without a high school diploma were obese, almost 11% higher than those who had
a college or graduate degree. Citing the 2007 National Survey of Childrens Health, it was found
that children with parents that are less educated have an obesity rate about three times higher
than children whose parents graduated college. There was also a relationship found between
children living below the federal poverty line and rates of obesity; obesity rates for those
children are almost three time higher. The webpage continues to list such statistics about obesity
patterns in children, with regards to economic status, education, parental education, and gender.
One advantage of this source is that, should I choose to use it directly as a source in my
argument synthesis paper, it provides a lot of statistics that would help boost my logos. The
information from this webpage also lists childhood obesity in relation to a childs socioeconomic
status, which is helpful because that explicitly details one of my controls. However, it focuses
largely on the educational influences on obesity, which strays from my topic. It also mainly
provides facts and percentages, so if I use this as a source in my argument paper, I would have to
synthesize the data on my own, which might not be as credible a source. Nonetheless, in general,
these hard facts will help me create a stronger argument in terms of providing hard evidence and
using these to support my thesis.

Walker R.E., Keane C.R., Burke J.G.. (2010). Disparities and Access to Healthy Food in the
United States: A Review of Food Deserts Literature. Health & Place, 16(5), 876-884.

The phrase food desert was first coined by a Scottish public housing resident and later
defined as urban areas with 10 or fewer stores and no stores with more than 20 employees
(Hendrickson et al., 2006), poor urban areas, where residents cannot buy affordable, healthy
food(Cummins and Macintyre, 2002), or an area where high competition from the multiples
[large chain supermarkets] has created a void (Furey et al., 2001). However, despite these
definitions by a few researchers, there has not been a general consensus on the defining
characteristics of food deserts, criteria to identify them, or if they even exist. There are many
theories as to how food deserts have formed. One such theory discusses the development and
closure of stores. This study is a review of past literature on the topic of food deserts; to find
articles the authors used keyword searches in databases and reviewed references of articles that
were found. Through their analysis, they found that the main causes and sources of food deserts
can be summarized in four categories: racial/ethnic disparities, income/socioeconomic status in
food deserts, difference in chain versus non-chain stores, and cost/availability of food items.
This study will be extremely beneficial because it discusses almost the exact topics I would like
to look into for my argument synthesis paper. One of my controls will focus on the prevalence of
food deserts in inner-city areas, and how that creates an inherent disadvantage for families of
lower socioeconomic status. The background section of this study records many of the different
definitions of food deserts that have been recorded by past researchers. The authors also point
out the debate over how one defines a food desert, from their criteria and characteristics to even
their existence. This part in particular helps me to gain an understanding of the background of
this issue and how professionals responded to this concept. My only concern is the time this was
written; this article looked at studies between 2008 and 2010. Although seven years might not be
a lot for some subjects of study, it can be significant for a field not already established. As the
authors stated, there is no set definition for food deserts, so new findings could have arisen
between the publishing date of this article and the present. However, because this study is a
review of past literature on a topic, it helps me to see other studies conducted in this area, and
has allowed me to easily find other related sources. One of the tables included by the authors
provided one sentence summaries for all of the articles reviewed. This was extremely helpful in
narrowing down which studies I should look into, and which ones werent related to my topic.
Wang, Y. & Lobstein, T. (2006). Worldwide trends in childhood overweight and obesity.
International Journal of Pediatric Obesity, 1. 11-25.

Our understanding of obesity and its effects on children are still very limited, due in part
to a lack of comparable data from different countries, as well as varying definitions for the
disease itself. This article compiled and summarized information on recent trends in pediatric
obesity by searching PubMed for articles including data trends over time. Additional studies and
expert consultation were also included in data collection, along with the World Health
Organizations Burden of Disease Program. Through all of this data, the researchers estimated
the likely prevalence levels for pediatric overweight and obesity in 2006 and 2010. Pediatric
obesity has definitely increased throughout almost all the countries for which data was available.
Exceptions were found among younger children in lower-income countries. Obesity was more
rapidly increasing in urbanized areas and economically developed countries. Researchers say that
with such variation in the obesity epidemic, effective programs and policies are needed at all
government levels to help promote health.

The authors of this article summarized trends in pediatric obesity, but through 1980 to
2005. A lot can happen in the span of 11 years, such as new discoveries or research, so I am a
little cautious about the information presented. Especially with such an unknown topic, I think
more recent studies might be more helpful. However, the methods for this study included a lot of
data collection, which might prove to be helpful if I were to talk about past trends and the rapidly
growing epidemic.

Zenk, S.N., PhD, Schulz, A.J., PhD, Israel, B.A., DrPH, James, S.A., PhD, Bao, S., PhD, Wilson,
M.L., ScD. (2005). Neighborhood Racial Composition, Neighborhood Poverty, and the
Spatial Accessibility of Supermarkets in Metropolitan Detroit. American Journal of
Public Health, 95(4). 660-667.

The objective of this study was to investigate the accessibility of chain supermarkets in
regards to racial composition and poverty rates. To assess accessibility, researchers used a
geographical information system to measure a Manhattan block distance and use that as the
unit of measurement. The distance to the nearest supermarket was then calculated for 869
neighborhoods in metropolitan Detroit, one of the most heavily segregated cities in America.
Census data was used to characterize the neighborhoods, and definitions were set to standardize
the terms used. A supermarket was defined as full-line grocery stores associated with a chain,
which was defined as a company with 11 or more stores. Researchers found that the distance to
the closest supermarket was similar among affluent communities; however, neighborhoods
comprised mainly of African Americans had supermarkets that were farther than white
communities. On average, they were 1.1 miles further. Supermarkets have opened or remain
open in middle-income communities that are now transitioning from white to African American
populations. The implications of this study point to the importance of development of
economically disadvantaged African American neighborhoods in preventing dietary diseases.
This study particularly focuses on the access to grocery stores of African American
neighborhoods within the Detroit area. The study population, then, is a very specific group of
people, but I think that the values and underlying patterns published in this article can be loosely
applied to other populations. The problem of socioeconomic status, with race tied into this issue,
plays a large role in the likelihood of childhood obesity and I think that this study will be a very
valuable source for both my background knowledge and possibly as a source for my paper.