Description

1.Research / statement question What is the main question / statement you wish to answer/ explore? Have you included a specific Public Health or Social Care Management Policy issue, target population and context (location) in your research question / statement? 2.Introduction What are the key areas which will be addressed in this research proposal? 3.Background and Rationale for the study Have you read around your research topic? Have you provided background information of important historical & contextual events and research which informs the reader why and how the Public Health or Social Care Management Policy issue you are interested in exists as a problem? What other studies have been conducted and what is their relevance to your chosen topic issue? Where relevant, have you evidenced the Public Health or Social Care Management Policy issue with appropriate comparative statistical evidence supported by relevant literature, including the most current sources? Where relevant have you evidenced the Public Health or Social Care Management Policy issue with appropriate qualitative evidence supported by relevant literature, including the most current sources? Have you explicitly explained why your chosen research topic issue is important to your field of practice? Have you presented a Thesis/ Justification Statement? i.e. objectively justifying why, you are interested in the chosen research topic? 4.Aim and Objectives What is the aim of the study – what do you want to achieve? (Identify one overall aim) Does the aim of the study resonate with your research question/ statement? What are the objectives of the study? (identify at least 4 – 5 objectives) Have you considered whether the aim and objectives actually describe what your proposed study intends to do, whether it’s realistic and reflects the requirements for analytical rigour expected at Masters Level? 5.Methodology You have a choice of conducting either Primary Research OR Secondary Research. If considering conducting Secondary Research you are required to address the following: Have you explained your selected methodological approach- e.g. secondary research versus primary research? Have you critically discussed the strengths and weaknesses of your chosen methodological approach while supporting this with relevant literature? Have you justified it? What is your Literature Search Strategy? i.e. How will you conduct your literature search? *What search engines will be used to search for the literature? *What academic & professional data bases will be accessed? *What Key words & Boolean operators will be used in the literature search? *What is your literature search exclusion and inclusion criteria and have you justified it? *What tools will you use to critically appraise the identified literature? If considering conducting Primary Research, you required to address the following: Have you explained your chosen methodological approach-i.e. Primary versus secondary research? Have you critically discussed the strengths and weaknesses of your chosen approach while supporting this with relevant literature? Have you justified it? Have you discussed and justified your: a) Data collection methods b) Study participants & Sampling technique/s) c) Data analysis method What is your Literature Search Strategy? i.e. How will you conduct your literature search? *What search engines will be used to search for the literature? *What academic & professional data bases will be accessed? *What key words & Boolean operators will be used in the literature search? *What is your literature search exclusion and inclusion criteria and have you justified it? *What tools will you use to critically appraise the identified literature? 6.Ethical Considerations How will you address this? Whether you are considering conducting Secondary Research or Primary Research, you must avoid plagiarism (which is a punishable academic offence), citing all literature sources appropriately etc. In addition, if considering conducting primary research, you are required to seek ethical approval from the Ethics Review Committee. Issues pertaining to data protection, confidentiality, voluntary participation, participant anonymization inter alia must be addressed – see next pages for further guidance). 7.Indicative Research Time table When will you start, and finish the dissertation? Have you fully considered all relevant stages in the research process by identifying specific targets/ actions for completion within specific time frames? (e.g. a table with two columns – one with a list your targets/ actions and another timeframe, i.e. specific dates) 8.References Have you provided a comprehensive reference list of all cited literature sources? Ethical considerations This is a very important part of a Primary Research based Dissertation and further information can be obtained from the University Research Ethics Policy web site http://www.londonmet.ac.uk/research/graduate-school/policy-and-strategy/research-ethics-policy.cfm. All students are encouraged to visit this site prior to commencing their dissertation.

Table of Contents

Effectiveness of Strategies to Curb Obesity Frequency among the United Kingdom’s Adolescents. 4

1.0:  Research Question. 4

2.0: Introduction. 4

3.0: Background and Rationale for the Study. 6

3.1: Social Determinants of Health. 6

3.1.1: The life-course model 8

3.1.2: The Total Environment Assessment Model: Early Childhood Development (TEAM: ECD) 9

3.2: Rationale for Study. 10

4.0: Aims and Objectives. 10

4.1: Research Aim.. 10

4.2: Research Objectives. 11

5.0: Methodology. 11

5.1: Secondary Research. 11

5.2: Literature Search Strategy. 13

5.2.1: Databases. 13

5.2.2: Exclusion/Inclusion Criteria. 13

5.2.3: Key Words and Boolean Operators. 14

5.2.3: Analysis Tools. 15

6.0: Ethical Considerations. 15

7.0: Indicative Research Timetable. 16

1.0:  Research Question

1. How effective are strategies to improve access to healthy food in reducing the prevalence of obesity in adolescents in the UK?

2.0: Introduction

Obesity is a global issue, and a significant public health issue in the United Kingdom (UK) as obesity rates are increasing even among younger people. Children, particularly adolescents, the power/autonomy to control what they consume as urbanization means more parents are away from home while internet technologies provide virtual parent/child interaction. As such, dietary habits become more established at adolescence and thus the rising obesity rates that predispose young people to grave long-term illnesses. According to Her Majesty’s Government (2016), more children between two and fifteen years are obese or overweight, and children are becoming more at risk for longer as obese children are more likely to die prematurely and contract Type 2 diabetes. Type two diabetes increases chances for a reduced quality of life due to blindness or limb amputation.  Not only does obesity influence conditions such as heart disease, but it also increases the risks of depression. In a briefing paper by the House of Commons, the costs of obesity rise to £8.3 billion in 2025 (Baker, 2019).  With increased rates of obesity in the UK (England, 15%; Northern Ireland, 9%; Scotland, 10%; Wales, 15 %), Baker suggested that the economic costs will increase immensely by 2025. If these trends increase the disease burden will also become much more intensive as obesity places adolescents at risk of severe illnesses.

Modern strategies that attempt to reduce or lessen obesity in the UK are numerous, but the rising trends depict a deteriorating health outcome. Procedures take both the upstream and downstream approach with the focus on tackling the low consumption of a balanced meal per day (5-a-day) to increase the intake of necessary minerals, to prevent irregular or more proportions (irregular intake) and most importantly to reduce the overreliance of fast foods. As well, strategies to augment health aimed at engaging schools, communities, and families. While the United Kingdom respects citizens’ consumer choices, economic realities, and the need to consume, the government takes various steps in developing tactics that enable healthy diets. One of the strategies used includes introducing levies to the soft drinks industry in a bid to limit the sugar content in the carbonated drinks. According to Brooks et al. (2015), teens are the most significant consumers for sugary beverages in Europe. Too much sugar leads to an augmented intake of too many calories and teeth decay. One can of soft drink contains up to 35gm sugar in a 330ml bottle. Public Health England, in conjunction with all industries, has been collaborated to reduce the sugar content in all foods and beverages to reduce the sugar intake by 20% (Zilberter and Zilberter, 2013). Besides sugar reduction, there are other tactics (policy) and individuals that the government has used to mitigate obesity.

Another strategy commonly used includes supporting innovation so that businesses can make healthier products. There is no doubt that innovation enhances leadership in aspects of health and nutrition. As well, there have been efforts to update the current nutrient model to encompass a more efficient model that assigns a score on food items to assess whether the ingredients contained are healthy. Another vital area in which policy has targeted includes making healthy foods available in public amenities such as schools as that impact on children. Also, poles that want to mitigate the central role of inactivity and obesity. There is a strong correlation between physical activity and exercise with reduced obesity rates. Current policies aimed at physical activity recommend children to have at least 60 minutes of play to enhance blood flow, reduce obesity, and augment creativity (Street, Wells, and Hills, 2015).  Most importantly, the government gives support to families of underprivileged households to encourage healthy diets. The significance of support to disadvantaged families supports the notion that social determinants of health affect families and hence adolescent obesity.

3.0: Background and Rationale for the Study

3.1: Social Determinants of Health

How people live to grow determines the extent of their quality of life. Almost all social determinants of health associated with the scope to which a person is affected by obesity. As relates adolescents, for instance, early childhood development is critical in progress because a child that receives opportunities for a stable development is likely to have long-term health and development. Some studies that have shown the significance of the early development stage is crucial for child development. According to Hurley, Yousafzai, and Lopez-Boo:

The provision of optimal infant and young children’s feeding practices depends upon the caregiver’s knowledge and capacity to provide age-appropriate feeding responsivity and nutritional sufficiency, quality, and diversity. The quality of care provided to young children by their caregivers, typically parents, is the most proximal factor that influences children’s survival, health, growth, and development. Early nutrition and development interventions depend on the knowledge, skills, and capacity— both emotional and financial—of caregivers to provide their young child with optimal care for development and nutrition (2016, Pg. 358).

Hence Hurley et al. illustrate that early childhood development is a critical factor for child development as it dictates a child’s future. Besides,  a child determined by other factors such as skill and nutritional sufficiency. According to Rai et al. (2015), poor nutrition begins at the womb and amplifies risk children getting retardation and limited capacity to handle the disease. Women with a low diet give birth to small nutrition-body babies who fall ill repeatedly. As shown in figure one, the health of a child s affected due to the proposed causal links that affect lifecycles. Thus, the lack of enough nutrients for a mother may have a significant impact on a child, but lack of social amenities, urbanization that leads to access to foods also interlay with early childhood development.   Social status, level of education, and type of employment in most parts of the world determine access to adequate foods. For minority groups and in particular, immigrants accessing healthy eating is a challenge, and hence children are at risk of getting poor diets that are more affordable. However, the causal links are vital in understanding how a child may have augmented health or derailed life.

Figure One: Lifecycle’s proposed causal links that may impact child development adapted from Kofi Annan’s Life Cycle Approach (2000).

3.1.1: The life-course model

The life course model asserts that underlying obesity pathways commence early in life and continue through the life course. For instance, a child’s fat cells are established based on how the body is composed n thus impact on the biological processes that control appetite, diet inclination, metabolism, fat deposition as well as insulin emission (Daniels, 2019). Accordingly, these epigenetic procedures change by altering gene purposes without modifying hereditary genetic factors. These insights then inform on why early childhood d may be critical in augmenting obesity in children. The life course model is vital as it sets a background for why improving diets among mothers would deter childhood obesity and also how adopting healthy foods may prevent adolescents from perpetuated obesity.

The life course model is vital as it shows how obesogenic surroundings lead people to their current positions. The model presents various risk factors that may be critical in understanding how adolescents respond to diverse aspects and the extent to which a person may react to these issues to gain optimum wellbeing. (Mamun, Mannan, and Doi, 2014). Hence, the life course model is vital as it explains the problems that may be causing obesity among adolescents. Elements that are vital in the model include plasticity, flexibility, and resilience; however, mobility is highest during early development.

3.1.2: The Total Environment Assessment Model: Early Childhood Development (TEAM: ECD)

The World Health Organisation (WHO) created the (TEAM: ECD) to explain factors that may impact a child’s healthy childhood but also through the life course. The objective of using this model is, in particular, a reference to early childhood development, a social determinant of health. The total environment assessment model is crucial because it shows that various processes, including behavioral as well as broader environmental contextual issues, are vital for child development.  For example, the economic, ecological, policy, political, and social environments highly determine a child’s growth and, thus, consumption. Another fact is that the epigenetics of a child and the social context of a mother may evaluate a child’s inclination to obesity (Park, Skaar, Jirtle, and Hoyo, 2017). However, this model advances the model to even other social factors such as residential community, culture, as well as the social environment. Hence, WHO created this model to the interplay between civil society, institutions, family, and the individual for optimum health functioning. Thus, the reason why adolescents are more likely to be at risk of obesity is not only because of behavior but also the environmental risk factors such as epigenetics. It is for this reason that the trans-generational passage of peril proposes how “obesity begets obesity” or how “healthy living begets healthy living” because even exposure to the harmful environment is likely to transfer severe threats to a person (Klengel, Dias and Ressler, 2016; Shaw et al., 2017).

3.2: Rationale for the Study

Investigating this subject is vital because it emphasizes and evaluates whether strategies in place are working to mitigate the level of obesity in the world today. Upstream approaches while have been fundamental in creating positive dietary behaviors, there seems to be a severe gap in tackling the role of epigenetics in developing poor habits. Policies would need to reduce the unhealthy intake of unhealthy foods because they highly determine the infant’s food decisions from adolescence into adulthood. Hence, the significance of this study is that it will use a narrative analysis approach to uncover literature on how adolescents and mothers’ stories and experiences can inform on the best policy tactics to reduce obesity among adolescents. The purpose of understanding and investigating obesity about causal links and social determinants may help mitigate the pervasive rates of obesity and other diseases that impact future generations through epigenetics and, ultimately, the trans-generational passage of risk. The study will be useful for both academics in the social health discipline and practices because this study links both social factors and epigenetics in understanding the effectiveness of strategies that reduce obesity among adolescents. In practice, this study will be vital for policymakers and practitioners of public health because tactics may not only be linked to social factors but also to epigenetics, which profoundly impacts on a teenager’s eating habits.

4.0: Aims and Objectives

4.1: Research Aim

1. To investigate whether the current strategies to improve access to healthy food are useful in lessening the rates of obesity among UK adolescents through a narrative review.

4.2: Research Objectives

1. To assess literature data to find how and why adolescents create perceptions of strategies available to reduce obesity.
2. To research how the theory of social constructionism interacts with access to healthy food and the resulting obesity among adolescents.
3. To extract peoples’ experiences and how they represent their lives on issues such as policy and attaining healthy foods.
4. To synthesize literature on social determinants that impact on access to healthy food to adolescents.

5.0: Methodology

5.1: Secondary Research

Secondary research is the primary approach for this study. Databases that provide quality data for availing ease of access to peer-reviewed journals that would otherwise be hard to find through search engines. According to Johnston (2017), “Secondary data analysis is an analysis of data that was collected by someone else for another primary purpose. The utilization of this existing data provides a viable option for researchers who may have limited time and resources”. The advantages of using specific databases help to identify needed data for secondary research quickly.  While databases are also extensive and avail diverse permission requirements, they are less costly to acquire, especially for students because institutions ensure that students can access all valuable information through databases specific to disciplines.

Thus, it is much easier and appropriate to access academic resources from a database such as PubMed as opposed to a database such as Hein Online that is vital for legal research or PsycINFO that specifically assists Psychology research. The ease of access and inexpensive way of finding data for a narrative review analysis is thus one significant advantage of secondary data research (Dale, Arber and Procter, 1988). Not only is secondary research cost-effective and convenient, but it accelerates research because the data is available. Another advantage is that secondary research, exceptionally when large, offers greater validity and generalizable findings. Most importantly, conducting such an analysis is vital as it provides opportunities for further study through replication and re-evaluation. Through secondary analysis, we can test new ideas, theories, as well as new research design methods. However,  Another limitation is that it requires the researcher to purposively become engaged in the research as entrusting another person with the investigation could invalidate the study due to a misunderstanding question. Therefore, conducting secondary research requires complete immersion of the subject and, thus, the link between the research question and the data collected to avoid invalidity issues.

Research notes that like primary research, secondary research is viable as long as it follows a systematic process. Creswell (2009) suggests that a research method attempts to collect, analyze and interpret data, and thus, secondary research is a practical approach that follows procedures and specific tests to respond to the study’s research question. The secondary research process begins by collecting previously collected data on a topic as data that exists may adequately answer a question. The advantage of using previously stated data in research is that it may contain data that was not fully utilized by researchers and can be used in the study to provide insightful aspects about the research (Johnston, 2012). After identifying the data, the researchers move to evaluate the data when the initial data has fulfilled all the requirements discussed to enable an appropriate fit with the research topic. The researcher can find the fit of the research data with the research question by carefully determining:

1. The objective of the research
2. Finding the responsible parties in the data collection process.
3. The collected information from the study
4. Dates/timelines of data collection
5. How the data in a literature review was collected/ obtained
6. The consistency of the data collected from the source in comparison to other sources (Stewart & Kamins, 1993).

5.2: Literature Search Strategy

5.2.1: Databases

One of the critical elements of this research is that it concerns a social public health problem. The primary databases utilized in answering the questions must then be relevant and appropriate for the study. As well, the databases must be comprehensive to cover crucial numerous journal articles that are (a) peer-reviewed, (b) be systematic reviews, or (c) empirical studies, among others. Thus, the central databases that are as vital for assessing whether strategies to curb obesity among adolescents are useful to include Google Scholar, PubMed, The Cochrane Library, and Social Sciences citation index.  These archives are all relevant for social sciences and provide insightful topics on obesity.

5.2.2: Exclusion/Inclusion Criteria

Firstly, it is essential to note that this study pertains to only adolescents and how strategies (policy or campaigns) are useful in curbing obesity. As such, the study will only concern adolescent topics. When conducting narrative analysis reviews, systematic reviews, or content analyses, researchers to use only recent peer-reviewed publications that can be as relevant and appropriate for obesity. The use of seminal works is highly discouraged because recent reviews contained updated perspectives on a study. Another criterion to follow is that the study will only use journal articles that are in the English language because the researcher may not have sufficient resources or the time for adequate translation.

5.2.3: Key Words and Boolean Operators

The leading Boolean operators used to search the databases are “AND” as well as “OR” because both operators can extend the research of journal articles. Perhaps it is best to consider that this research will not use “NOT” as it would risk eliminating necessary items in the study. As well, the analysis will identify various keywords and synonyms that can be used in the study as they would help narrow down a topic. The table below distinctively identifies synonyms for “OR” to broaden the search. The researcher will include “AND” to narrow the research to the UK. However, a more general search is crucial as it would identify the UK, EU, and the US.

Table One: Keywords used for the research for “OR” to broaden the research:

5.2.3: Analysis Tools

The importance of using narrative review analysis is that it uses existing literature to find answers to the question under investigation. Using Microsoft Word’s Excel, the researcher will manually document the essential findings and then summarise the data. Excel as it is a readily available and dynamic tool to document and categorize data.

6.0: Ethical Considerations

Research ethics concerns how to treat data after it has collected, and every discipline encompasses distinctive ethical guidelines. The realms of narrative analysis are very different from other approaches in that the researcher uses literature to comprehend experiences and stories. While privacy or informed consent may not apply in narrative analysis, plagiarism is a risk that may place whole research under threat. Avoiding peoples’ ideas, whether intentionally or accidentally or failing to give full credit to the work, is highly unprofessional and a severe academic and intellectual offense to consider. To mitigate paper retractions and loss of author credibility, it is thus vital for all researchers to have the highest ethical attitudes. In some academic traditions, authentication may not be as essential. Still, the global academic code of conduct not only insists on an academic code of conduct but ethical uprightness when conducting research. It appears that there are a few key issues that may affect narrative review analysis, including ownership and intellectual property rights, the honesty of life stories, misrepresentation for the communities or individuals studies, and Deconstructing assumptions of ’empowerment.’ As historical research is about obtaining and reflecting on a person’s or a community’s lived experiences, researchers thus must protect the dignity of the people studied.

According to Vanderstoep and Johnson, institutions of higher learning have Research Ethics committees (REC) that oversee research projects, and proposals must be approved before data collection begins (2009, Pg. 12). Thus, the researcher will submit a thorough plan for data collection. Because this study does not directly involve participants, there a copy of the informed consent sheet will not be required. However, the researcher will be required to provide a description of the sample as well as instruments that will as used to collect data. Since the burden of ethical conduct lies with the researcher, and then it is vital to maintain the highest standards of ethics throughout the research.

7.0: Indicative Research Timetable

The final submission for the study will be in September, and thus, the research schedule has divided into nine sections. The Gantt chart in Appendix A shows that the project will begin within February after the IRB approval. The search for the databases begins in February using keywords and Booleans before reading through abstracts and then finally skimming through content to find twenty most relevant peer-reviewed articles. By August, the researcher will have finished the literature review and began the narrative analysis. The last month before submission includes combining all parts of the literature review with the sequential analysis before the final presentation.

References

Annan, K., 2000. Global nutrition challenges: a lifecycle approach. Food Nutr Bull, 21, pp.18-34.

Baker, C., 2019. UK Obesity Statistics for the House of Commons. Available at https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN03336, (Accessed: 26 December 2019).

Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N., and Smeeton, N., 2015. HBSC England National Report: Health behavior in school-aged children (HBSC): World Health Organization collaborative cross-national study.

Creswell, J.W., and Creswell, J.D., 2017. Research design: Qualitative, quantitative, and mixed methods approach. Sage publications.

Dale, A., Arber, S., and Procter, M., 1988. Doing secondary analysis. Unwin Hyman.

Daniels, L.A., 2019. A Life-Course Model of Obesity: Primary and Secondary Interventions to Prevent Childhood Obesity. Multidisciplinary Digital Publishing Institute Proceedings, 8(1), p.59.

Her Majesty’s Government, 2016. Childhood Obesity: A Plan For Action. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/546588/Childhood_obesity_2016__2__acc.pdf, (Accessed: 26 December 2018).

Hurley, K.M., Yousafzai, A.K., and Lopez-Boo, F., 2016. Early child development and nutrition: a review of the benefits and challenges of implementing integrated interventions. Advances in nutrition, 7(2), pp.357-363.

Johnston, M.P., 2012. Connecting Teacher Librarians For Technology Integration Leadership. School Libraries Worldwide, 18(1).

Johnston, M.P., 2017. Secondary data analysis: A method of which the time has come — qualitative and quantitative plans in libraries, 3(3), pp.619-626.

Klengel, T., Dias, B.G., and Ressler, K.J., 2016. Models of intergenerational and transgenerational transmission of risk for psychopathology in mice. Neuropsychopharmacology, 41(1), p.219.

Mamun, A.A., Mannan, M., and Doi, S.A.R., 2014. Gestational weight gain about offspring obesity over the life course: a systematic review and bias‐adjusted meta‐analysis. Obesity Reviews, 15(4), pp.338-347.

Park, S.S., Skaar, D.A., Jirtle, R.L., and Hoyo, C., 2017. Epigenetics, obesity, and early-life cadmium or lead exposure. Epigenomics, 9(1), pp.57-75.

Rai, R.K., Kumar, S., Sekher, M., Pritchard, B., and Rammohan, A., 2015. A lifecycle approach to food and nutrition security in India. Public health nutrition, 18(5), pp.944-949.

Shaw, J.L., Judy, J.D., Kumar, A., Bertsch, P., Wang, M.B., and Kirby, J.K., 2017. Incorporating transgenerational epigenetic inheritance into ecological risk assessment frameworks. Environmental science & technology, 51(17), pp.9433-9445.

Smith, A.K., Ayanian, J.Z., Covinsky, K.E., Landon, B.E., McCarthy, E.P., Wee, CC, and Steinman, M.A., 2011. Conducting high-value secondary dataset analysis: An introductory guide and resources. Journal of general internal medicine, 26(8), pp.920-929.

Stewart, D.W., Stewart, D.W., and Kamins, M.A., 1993. Secondary research: Information sources and methods (Vol. 4). Sage.

Street, S.J., Wells, J.C.K. and Hills, AP, 2015. Windows of opportunity for physical activity in the prevention of obesity. Obesity Reviews, 16(10), pp.857-870.

Vanderstoep, S.W., and Johnson, D.D., 2008. Research methods for everyday life: blending qualitative and quantitative approaches (Vol. 32). John Wiley & Sons.

Gilbert, T., and Gilbert, E.Y., 2013. Breakfast and cognition: sixteen effects in nine populations, no single recipe. Frontiers in human neuroscience, 7, p.631.

integrated nutrition

and early child development intervention may have additive

or synergistic benefits for child development

Appendix A