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Obesity in Adolescents

Delkis Rodriguez Universidad del Turabo

NR502: Proposal

May Session, 2020

This paper is submitted in partial fulfillment of the requirements for the Master of Nursing Practice degree.

Running head: OBESITY IN ADOLESCENTS 1

Running head: OBESITY IN ADOLESCENTS 1

Obesity in Adolescents

Obesity can be defined as a complex condition involving excessive body fat. Obesity is caused by overweight whereas overweight is caused by an imbalance between energy intake and energy expenditure (Rosenthal et al., 2017). In the last thirty years, Obesity was identified as a disease of the wealthy and a disease that is common in adults. However, by studying obesity trends, the assumptions around obesity have been dispelled. In the last twenty years, obesity rates in the country and the world, in general, have increased.

According to data from the National Health & Nutrition Examination Survey in 2019 approximately 39% of American adults are obese. In addition, 18.9% of children between 2 and 19 years are obese: 13.7 million children in the nation are obese (Henry, 2018). Out of the 13.7 million children 20.6% are adolescents and they make the largest number of children who are obese. The World Health Organization defines adolescents as individuals who are between 10 years and 19 years (Johnson, 2018). Approximately, 2.8 million adolescents are obese in the United States (Wang et al., 2017). The trend is a growing concern considering that it is the adolescent age that is least expected to be obese considering the lifestyles of the age group. There is a need to curtail obesity lest the health of the nation is further compromised. The purpose of this literature review will be the revision of relevant article related with Obesity in adolescents.

Significance of the Practice Problem

Adolescents are expected to be healthy as they mostly participate in physical exercises and other activities that demand energy expenditure. With technological advancement adolescents as we know them have changed. They no longer participate in physical exercises as much as they are known to. Instead, they spend most of their time seated playing computer/video games and on social media platforms. To make matters worse, the majority of the manufactured food that is consumed in the nation is unhealthy; it is high in cholesterol and rich in processed sugar (Rolland-Cachera & European Childhood Obesity Group, 2017). The eating of food high in cholesterol and the lack of physical exercise is exposing adolescents to health risks.

If the condition is not arrested adolescents as well as the general public is at risk. Obese adolescents are at risk of developing obese related complications such as heart diseases, type II diabetes, high blood pressure, and certain cancers such as breast and colon (Poursafa et al., 2018). Considering, that adolescents are not an income-generating group, having ill health due to obesity drains family incomes as finances and related resources are directed to cater for their ill health (Tyson & Frank, 2018). Furthermore, ill adolescents compromise on the future growth of the nation. Obese adolescents are more likely to spend more time in health centers treating obesity and related complications in the future thereby reducing their productivity rates.

The quality of life for not only obese adolescents is at risk but also the quality of life for the general public is at risk. The constant treatment of lifestyle diseases is bound to increase the cost of care which will affect all people negatively (Wang et al., 2020). Due to obesity and related complications hospital readmissions are going to be frequent. Failure to secure adolescents from obesity will put the nation’s health at risk which in turn will hurt the nation’s productivity. It is important that the obesity rate more so in adolescents is significantly reduced. Emphasis has been placed on the need for lifestyle changes in adolescents as a way of reducing obesity. To confirm or dispel the need of lifestyle change the following research question will be used:

PICOT Question

Are adolescents (P) that participate in healthy lifestyles such as physical exercise and healthy eating (I) at a decreased risk of obesity complications (O)compared to adolescents that participate in unhealthy lifestyles such as smoking, avoiding physical exercises and eating unhealthy foods(C) in the long run? (T)

Objectives

1. To identify risk factors for obesity in adolescents to enlighten the public to reduce not only obesity amongst adolescents but also in the other ages.

2. To identify how lifestyle choices impact obesity in adolescents.

3. To identify solutions and interventions that can reduce obesity in adolescents to save not only the health of adolescents but the nation’s health.

Theoretical Framework

Two theories will guide the study on adolescents and obesity. The first theory will be the self-efficacy theory by Bundra which was coined from the social cognitive theory. The self-efficacy theory emphasizes that one can manage one’s health. The theory recognizes the role that an individual has in their health (Brandão et al., 2019). It, therefore, encourages nurses to make people self-reliant by educating them. The theory will be used in the study as it offers a guide towards a preventive strategy against obesity in adolescents.

The second theory that will be used is the change theory by Lewin Kurt. The theory focuses on the change process and will be ideal for the study as the study’s focus is changing the current obesity rate in adolescents for the better. The theory is pegged on three major concepts. The first concept is driving forces, the second concept is restraining forces and the last concept is equilibrium. The driving forces are those that cause change and they facilitate or cause change as they push patients towards a specific direction. Restraining forces are the forces that are against the direction that a patient is being pushed to; they counterchange. On the other hand, equilibrium is a situation in which the restraining forces equal driving forces, thereby change does not happen. The ideal situation for nurses and the health sector is that the driving forces always win over the restraining forces for proper health to be possible. The change theory is ideal for the study as it focuses on strengthening the driving forces towards the fight against obesity in adolescents.

Synthesis of the Literature

In a study published in 2018 in the Pubmed online database by Anne Martin and five other researchers part of the University of Edinburgh Medical School, physical activity, diet, and behavioral interventions such as behavior therapy are ideal for helping adolescents and children with obesity. The researchers conducted a case study research in 2017 where they searched MEDLINE, CENTRAL, and fifteen other databases (Martin et al., 2018). In total, the team studied 59 records of 2384 of adolescents and children with obesity. According to the study, the risk factors for obesity in adolescents are physical exercise and diet.

Serbia just like the United States has had its obesity rates in children and Adolescents increase significantly. In an attempt to understand the risk factors associated with the condition and the identified population, Katarina Borcic, and three other researchers conducted a cross-sectional study of 2139 adolescents in Serbia. The results of the study were over 50% of the study population was overweight and that boys were more overweight compared to girls (Boričić et al., 2014). The risk factors identified for obesity in the study were lack of physical activity that exceeds 7 hours a week and poor diets.

Anna Olafsdottir, Johanna Torfadottir, and Sigurbjorn Arngrimsson conducted a cross-sectional study in 2016 to identify metabolic and health behavior risk factors of obesity in adolescents. They studied 182 subjects of which 47% were female (Olafsdottir, Torfadottir & Arngrimsson, 2016). The results of the study identified the lack of physical exercise and poor nutrition as the primary causes of obesity in adolescents. Emphasis was placed on the adoption of healthy lifestyles as a way to beat obesity.

In an article published in 2018 by Nirmala and three other authors about a case-control study in Kancheepuram district, dietary, family, and behavioral factors are risk factors for obesity. The researchers studied 1656 adolescents between 12 and 15 years randomly picked from twelve schools and they used regression and multivariate logistic (Nirmala, Kanniammal, & Venkataraman, 2018). Recommendations of the study were adolescents to be educated on healthy eating and healthy lifestyles to avoid obesity.

According to an article published in 2017 in the International Journal of Contemporary Pediatrics, the consumption of processed and fast foods, over dependency on computers and televisions and less physically active lifestyles are the primary cause of obesity in adolescents of Jaipur (Choudhary et al., 2017). The findings were based on a cross-sectional analytical study in schools in the area. Girls were found to be more obese than boys. The recommendations of the study were increased hours of physical activity every day and healthy diets to reduce overweight and obesity in adolescents.

In an article published by Ying‐Hui Quek and three other researchers, depression is a risk factor for obesity in children and adolescents. The researchers conducted a meta-analysis that involved going through Science Direct, EMBASE, and PsycInfo for studies that compared the prevalence of depression. A total of 51, 272 participants were pooled and examined (Quek et al., 2017). The findings of the study indicated that the female gender was the most likely to suffer from depression and obesity an indication that depression is a risk factor for obesity.

Canada is another country with high obesity rates in its Adolescents. In an attempt to understand risk factors Frank Elgar and five other researchers conducted a quantitative study. They tested out whether differences in socioeconomic status are a risk factor for obesity and found out that it contributes to lifestyle risk factors of the condition. The researchers tested their hypothesis using data of 25890 adolescents between the ages of 11 and 15 years (Elgar et al., 2016). According to the study relative depression plays a role in obesity where relative depression related to the skipping of breakfast, fewer health choices, and less physical activity.

In an article published in 2017 Yavuz Tokgöz and his team of 7 carried out a test trial to check whether perilipin polymorphisms are a risk factor for obesity. The trial involved 108 adolescents between 10 and 18 years (Tokgöz et al., 2017). The study involved studying the PLIN gene. The results of the study confirmed that PLIN 6 polymorphism of the perilipin gene can influence obesity in adolescents but is not a significant risk factor.

In an article published in 2018 by Lopez-Sandoval and five other researchers, the researchers found out that cardiovascular diseases such as hypoadiponectinemia, dyslipidemia, and subclinical inflammation are risk factors for obesity in adolescents. The researchers used a transverse analytical study to reach their findings (Lopez-Sandoval et al., 2018). In total, the researchers used 83 adolescent participants.

Another nation that has high obesity rates in adolescents in Turkey. In a study aimed at identifying risk factors for adolescents in Turkey, Hasan Hüseyin Eker and five other researchers through a cross-sectional study of 1357 adolescents found out that low physical activity, overeating, higher social status were risk factors for obesity (Eker et al., 2018). The researchers recommended that proper eating habits and regular exercise should be encouraged to counter obesity among adolescents.

In an article published in 2018, Janine Narciso and six other researchers studied cases on obesity in adolescents in Scopus and PubMed in an attempt to uncover risk factors for obesity. In total 40 publications were found fit for the study (Narciso et al., 2019). The risk factors identified include genetic factors, socioeconomic status, physical activity, and diet.

Just as in the United States, Sri Lanka’s adolescents have high obesity rates. Due to concern, Sunita Arora and two other researchers decided to conduct a hospital-based cross-sectional study of adolescents. They studied 218 adolescents of which 51% were female. The results of the study indicated that fast food consumption was the main risk factor for obesity (Arora, Gupta & Singh, 2017). Another main risk factor for the condition is the lack of participation in physical activity of at least 30 mins every day.

In an article published in 2017 by Lena Al‐Khudairy and thirteen other researchers found out that physical activity, diet, and behavioral interventions were ideal for treating overweight and obesity. The results of the study were realized through a systematic literature search (Al‐Khudairy et al., 2017). Based on the results of the study, the lack of enough physical exercise, poor eating habits, and lifestyle choices were the main risk factors for obesity in adolescents.

In 2017, Katherine W. Bauer and three other researchers published their study on the risk factors for obesity in adolescents. Through a cross-sectional study of 2706 participants, the researchers were able to identify personal and behavior concerns as well as socio-environmental factors as the main risk factors for overweight and obesity (Bauer et al., 2017). The researchers found out that a diminishing lifestyle contributed to obesity in young adults.

In an article published in 2016, Youngdeok Kim and two other researchers reported their findings on the obesity of US adolescents. Through a latent class analysis of data collected through a survey of 12081, the researchers identified that physical activity and sedentary behavior were the main risk factors for obesity in the young adults (Kim, Barreira & Kang, 2016). About the findings, the three researchers recommended that sufficient levels of physical activity and reduced sedentary behavior should be encouraged to reduce obesity rates.

Michelle Cardel and fourteen other researchers conducted a randomized study in Hispanic adolescents and published the findings in 2019. A total of 133 adolescents were studied. The findings of the study were that social status and food security were risk factors for obesity among female Hispanic adolescents (Cardel et al., 2019). Adolescents from a poor background were at high risk of obesity compared to those from higher social-economic status, an indication that obesity rates among adolescents were influenced greatly by socio-economic status and food security.

Obesity rates in adolescents in China have also increased. In a study to understand why the rates have increased Qi Xie and eight other researchers conducted a cross-sectional survey study in China. The survey had 536 college student participants. The questions in the survey were on eating habits. According to the results of the study 6 factors influence obesity in adolescents; the number of meals eaten per day, speed of eating, residence, sex, and diet rich in sugars (Xie et al., 2019). Recommendations from the study centered on eating healthy meals as a way of avoiding obesity.

American adolescents are not the only ones affected by obesity as evidenced by high obesity rates among adolescents from South Asia. In an article published by Jayawardena Ranil and four other researchers conducted a study on obesity and found out that nutrition was the main risk factor for obesity. The researchers conducted a four-stage systematic search. The research team identified certain foods such as fast foods that contributed to the poor health status of South Asia adolescents (Jayawardena et al., 2017). They recommended that nutritious meals should be consumed to reduce the chances of obesity.

In an article published in 2016, Septi Viantri Kurdaningsih and two other researchers identified that there are two main risk factors of obesity in adolescents: sedentary lifestyles and physical activity. The researchers conducted a cross-sectional study using data collected from the observation method. The study involved 184 high school students. Analysis of the collected data was analyzed using multiple logistic regressions and chi-square tests (Kurdaningsih, Sudargo, T., & Lusmilasari, 2016). Recommendations of the study were that adolescents need to participate more in regular physical exercises and eat nutritious meals in moderation.

In an article published in 2018, Bożena Glinkowska and Wojciech M. Glinkowski reported on a study that they had conducted in Poland. The two researchers used an internet-based survey to collect information on obesity concerning the participation of adolescents in sports and physical activities (Glinkowska & Glinkowski, 2018). According to the study, participating in regular physical activities lowers the likelihood of obesity in adolescents, an indication that the lack of participation in physical activity is a risk factor for obesity.

Practice Recommendations

Based on the literature synthesis the research question, are adolescents that participate in healthy lifestyles such as physical exercise and healthy eating at a decreased risk of obesity complications compared to adolescents that participate in unhealthy lifestyles such as smoking, avoiding physical exercises and eating unhealthy foods, in the long run, is answered. The main recommendations that can be picked from synthesis touch on the need for physical exercise and healthy eating as a way of avoiding obesity and also as solutions of reducing overweight and obesity in adolescents

There are ten recommendations from the literature synthesis. The recommendations are based on the identified risk factors of obesity. Top on the list is participation in physical activities. Glinkowska and Wojciech (2018), recommend that to reduce obesity in adolescents, there is an immediate need for adolescents to participate in regular physical activities. The second recommendation is still on the participation of physical activities. Kim, Barreira, and Kang (2016) recommend that adolescents participate in at least an hour of physical activities.

The third recommendation is on the participation of adolescents in physical exercises. It is recommended that they should participate in physical activities that increase their heartbeats. According to Al‐Khudairy et al (2017), activities such as jogging, jumping rope, and playing team sports such as basketball and soccer are recommended. The fourth recommendation is on nutrition. Emphasis is placed on the eating of nutritious meals. According to Elgar et al (2016), adolescents should eat balanced diets to reduce the likelihood of becoming obese.

Fifthly, adolescents should avoid eating fast foods. Kurdaningsih et al (2016) recommend that adolescents should also avoid foods high in cholesterol, processed foods, and foods that have high sugar levels. The sixth recommendation is on eating habits. Ranil et al (2017) recommend that adolescents should avoid skipping meals more so breakfast. They should also avoid eating. In addition, adolescents as well as other age groups should avoid eating late in the evening or when they are about to sleep. It is recommended that they eat their meals slowly to maintain their metabolic rates.

The seventh recommendation is on the adoption of healthy lifestyles. They are adolescents that smoke as well as take alcohol. Arora, Gupta, and Singh (2017) recommend that adolescents should avoid alcohol and other substances as they open their bodies to health conditions that are risk factors of obesity such as cardiovascular diseases. The eighth recommendation is on medical checkups. According to Lopez-Sandoval et al (2018), adolescents must go for regular checkups as the checkups will help in the early identification of diseases that are risk factors for obesity. The checkups will also provide advice for those that are at risk of genetic obesity.

The ninth recommendation is the push for the improvement of the economic status of the society. According to Cardel et al (2019), policies and strategies should be in place to help people improve their socioeconomic status. The recommendation is appropriate considering that socio-economic status is a risk factor for obesity. The last recommendation is that adolescents should have their mental health checked. Depression has been identified to influence obesity in adolescents. Quek et al (2017), insist parents and the government must work to ensure that adolescents are not depressed lest the obesity rate increases further.

Project Description

This project will be completed through a literature review. This will be carried out through Google Scholar, CINHAL, Ana G. Mendez Virtual Libraries, WorldCat, PubMed, Internet database. The research will be peer-reviewed. A minimum of 20 articles of no more than 5 years will be reviewed. I will use some keywords for my search like risk factors, obesity, adolescents, physical activity, sedentary behavior, overweight.

The results obtained from the study will contribute to determine the risk factors for obesity in adolescents identifying how lifestyle choices impact in this health issue and search for interventions that can reduce obesity in adolescents to save not only the health of adolescents but the nation’s health.

All information collected in this review will be kept in a locked dresser in the principal investigator’s office for 5 years. Both, the principal investigator, and the mentor will have access to this material. After this time (5 years), the data will be eliminated with a paper shredder and discarded.

Project Evaluation Results

Summarize tables with all citations will be presented in appendix A&B; appendix A will be used for the summary of primary research evidence, and appendix B will be used for the summary of the systematic reviews.

Appendix A will include the citation, question or hypothesis, and theoretical foundation, research designated and sample size, key findings, recommendations or implications, and level of evidence, of each article. Appendix B will include citations, question, search strategy, inclusion/exclusion criteria, data, extraction and analysis, key finding, recommendation/implications, and level of evidence of each article.

Discussion and Implications for Nursing and Healthcare

The study has revealed that obesity is not only a lifestyle condition but is also a condition that has many diverse risk factors. The findings of the study are instrumental in the advancement of healthcare not only to adolescents but to all generations considering that all ages are at risk of obesity and related conditions. Through the study, five key points have been identified to be of relevance to the health sector.

The first key point is the need to emphasize the importance of physical exercise. Nurses and the health sector in general have always claimed that participation in physical activity is important. However, with the new findings from the study, physical activity should be sold as a necessity for good health. Nurses need to enlighten masses on regular physical exercise that exceeds an hour every day.

The second key point is on the treatment and interventions given for adolescents identified to be obese. For a long time, the nursing fraternity has advised that obese people should reduce their food intake to reduce obesity (Deitel, 2016). Through the study, it is possible to identify the need for the nursing fraternity to advise obese adolescents to adopt healthy eating habits. Emphasis should be placed on not skipping meals, avoidance of fast foods and goods high in cholesterol, and processed sugar.

The third key point is on the treatment of obesity as a condition that originates from poor behavior. The repercussions of obesity not only individual adolescents but on the nation are too high. The nation risks having unproductive people in the future as well as risks having generally poor health by having adolescents obese. The role that nurses play is the nation’s health is significant and there is a need for them to adopt new measures to counter the growing prevalence of obesity among adolescents. The results of the study have revealed that obesity is a condition that originates from poor behavior and for that reason the health fraternity should treat it as so to reduce the burden of health provision to the general public.

The fourth key point is that the nurses and the health sector have a reliable solution for obesity in adolescents. The findings of the results have indicated that for one not to be overweight or obese they have to do a combination of three things regardless of whether obesity is genetic or not. They first have to participate in physical activities regularly and consistently. Secondly, they have to eat healthy foods and in moderation. Lastly, they must adopt healthy lifestyles to avoid diseases that are risk factors of obesity.

The last key point is that obesity is a condition that can be easily dealt with. The study has proven that obesity is behavior diseases and not a viral or any other type of disease. The fact that it is a behavioral condition implies that it can be dealt with by instituting good behavior. Considering that nurses and the health sector are the custodians of health in the nation and globally, they must lead in fighting obesity by instituting behavioral change. Nurses are best placed to fight obesity in adolescents. Based on the findings of the study, health institutions can classify obesity as behavioral diseases and institute measures to reduce the current obesity rates in adolescents as well as other age groups.

Plans for Dissemination

To achieve the purpose of making our research known, different types of media will be used. In the same way interpersonal communication will be of vital importance to disseminate this project. Also, other forms of dissemination will be used as a PowerPoint, and a poster will be presented at the Ana G Mendez University. The PowerPoint will have a duration of no more than 30 minutes and will be presented to the teacher and classmates. While the poster, which will include a summary of this research, will be shown in the Ana G Mendez University room of the South Florida campus. In the library of this university we will leave a copy of this literature review to be used by those who are interested in the subject.

Summary and Conclusion

The study had three main purposes; to identify risk factors for obesity in adolescents to enlighten the public to reduce not only obesity amongst adolescents but also in the other ages, to identify how lifestyle choices impact obesity in adolescents and to identify solutions and interventions that can reduce obesity in adolescents to save not only the health of adolescents but the nation’s health. All the three objectives of the study were geared at confirming or dispelling the hypothesis that adolescent that participate in healthy lifestyles such as physical exercise and healthy eating at a decreased risk of obesity complications compared to adolescents that participate in unhealthy lifestyles such as smoking, avoiding physical exercises and eating unhealthy foods in the long run.

Based on the literature synthesis the research question and the hypothesis were confirmed. In addition, the synthesis helped by providing 10 recommendations as concerns obesity in adolescents. The recommendations are participation in regular physical activities that exceed over an hour daily and that increases their heartbeats. In addition, adolescents should eat nutritious meals avoid fast foods and adopt healthy eating habits. Furthermore, adolescents should adopt healthy lifestyles. They should also go for regular medical checkups. The government should look for ways to improve the socio-economic status of its people. Lastly, parents and the government must work to ensure that adolescents are not depressed lest the obesity rate increases further.

The study has helped reveal that obesity is not only a lifestyle condition but is also a condition that has many diverse risk factors. The findings of the study are instrumental in the advancement of healthcare not only to adolescents but to all generations considering that all ages are at risk of obesity and related conditions. Through the study, five key points have been identified to be of relevance to the health sector.

The first key point is the need to emphasize the importance of physical exercise. The second key point is on the treatment and interventions given for adolescents identified to be obese. Through the study, it has been possible to identify the need for the nursing fraternity to advise obese adolescents to adopt healthy eating habits. The third key point is on the treatment of obesity as a condition that originates from poor behavior. The results of the study have revealed that obesity is a condition that originates from poor behavior and for that reason the health fraternity should treat it as so to reduce the burden of health provision to the general public. The fourth key point is that the nurses and the health sector have a reliable solution for obesity in adolescents. The findings of the results have indicated that for one not to be overweight or obese they have to do a combination of three things regardless of whether obesity is genetic or not. They first have to participate in physical activities regularly and consistently. Secondly, they have to eat healthy foods and in moderation. Lastly, they must adopt healthy lifestyles to avoid diseases that are risk factors of obesity. The last key point is that obesity is a condition that can be easily dealt with. The study has proven that obesity is behavior diseases and not a viral or any other type of disease. The fact that it is a behavioral condition implies that it can be dealt with by instituting good behavior.

References

Al‐Khudairy, L., Loveman, E., Colquitt, J. L., Mead, E., Johnson, R. E., Fraser, H., … & Azevedo, L. B. (2017). Diet, physical activity, and behavioral interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane database of systematic reviews, (6). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012691/abstract

Arora, S., Gupta, S., & Singh, P. (2017). Assessment of risk factors for hypertension and obesity among adolescents. Sri Lanka Journal of Child Health46(1).

Bauer, K. W., Marcus, M. D., Larson, N., & Neumark-Sztainer, D. (2017). Socioenvironmental, personal, and behavioral correlates of severe obesity among an ethnically/racially diverse sample of US adolescents. Childhood Obesity13(6), 470-478.

Boričić, K., Simić, S., Vasiljević, N., & Marinković, J. (2014). Risk Factors Associated with Overweight among Adolescents in Serbia/Dejavniki Tveganja, Povezani S Prekomerno Telesno Težo Pri Mladostnikih V Srbiji. Slovenian Journal of Public Health53(4), 283-293. doi: 10.2478/sjph-2014-0031

Brandão, M. A. G., Barros, A. L. B. L. D., Caniçali Primo, C., Bispo, G. S., & Lopes, R. O. P. (2019). Nursing theories in the conceptual expansion of good practices in nursing. Revista brasileira de enfermagem72(2), 577-581.

Cardel, M., Pavela, G., Janicke, D., Dulin, A., Huo, T., Miller, D., … & Peters, J. (2019). The Effects of Experimentally Manipulated Social Status and Food Insecurity on Acute Eating Behavior and Risk for Obesity Among Adolescents: A Randomized Controlled Study (P21-058-19). Current developments in nutrition3(Supplement_1), nzz041-P21. doi.org/10.1093/cdn/nzz041.P21-058-19

Choudhary, K., Mathur, P., Garg, M., Gupta, P. P., & Choudhary, K. (2017). Prevalence of overweight and obesity amongst adolescents and identification of risk factors. Int J Contemp Pediatr4(4), 1-7.

Deitel, M. (2016). Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obesity surgery, 13(3), 329.

Eker, H. H., Taşdemir, M., Mercan, S., Mucaz, M., Bektemur, G., Şahinoz, S., & Özkaya, E. (2018). Obesity in adolescents and risk factors. Turkish Journal of Physical Medicine and Rehabilitation64(1), 37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709607/

Elgar, F. J., Xie, A., Pförtner, T. K., White, J., & Pickett, K. E. (2016). Relative deprivation and risk factors for obesity in Canadian adolescents. Social Science & Medicine152, 111-118. doi.org/10.1016/j.socscimed.2016.01.039

Glinkowska, B., & Glinkowski, W. M. (2018). Association of sports and physical activity with obesity among teenagers in Poland. International journal of occupational medicine and environmental health31(6), 771-782. doi.org/10.13075/ijomeh.1896.01170

Jayawardena, R., Ranasinghe, P., Wijayabandara, M., Hills, A. P., & Misra, A. (2017). Nutrition transition and obesity among teenagers and young adults in South Asia. Current diabetes reviews13(5), 444-451.

Johnson, D. (2018). The Obesity Epidemic. Retrieved from https://digitalcommons.murraystate.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1147&context=bis437

Kim, Y., Barreira, T. V., & Kang, M. (2016). Concurrent associations of physical activity and screen-based sedentary behavior on obesity among US adolescents: a latent class analysis. Journal of Epidemiology26(3), 137-144. doi.org/10.2188/jea.JE20150068

Kurdaningsih, S. V., Sudargo, T., & Lusmilasari, L. (2016). Physical activity and sedentary lifestyle towards teenagers’ overweight/obesity status. International Journal of Community Medicine and Public Health3(3), 630-635.

Lopez-Sandoval, J., Sanchez-Enriquez, S., Rivera-Leon, E. A., Bastidas-Ramirez, B. E., Garcia-Garcia, M. R., & Gonzalez-Hita, M. E. (2018). Cardiovascular Risk Factors in Adolescents: Role of Insulin Resistance and Obesity. Acta Endocrinologica (Bucharest)14(3), 330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525782/

Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet, and other behavioral interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. The Cochrane database of systematic reviews3(3), CD009728. https://doi.org/10.1002/14651858.CD009728.pub4

Narciso, J., Silva, A. J., Rodrigues, V., Monteiro, M. J., Almeida, A., Saavedra, R., & Costa, A. M. (2019). Behavioral, contextual, and biological factors associated with obesity during adolescence: a systematic review. PloS one14(4). https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0214941

Nirmala, A., Kanniammal, C., & Venkataraman, P. (2018). Predisposing factors associated with obesity among adolescents-A case-control study. www.biomedres.info/biomedical-research/predisposing-factors-associated-with-obesity-among-adolescentsa-case-control-study-10870.html

Olafsdottir, A. S., Torfadottir, J. E., & Arngrimsson, S. A. (2016). Health behavior and metabolic risk factors associated with normal weight obesity in adolescents. PLoS One11(8).

Poursafa, P., Dadvand, P., Amin, M. M., Hajizadeh, Y., Ebrahimpour, K., Mansourian, M., … & Kelishadi, R. (2018). Association of polycyclic aromatic hydrocarbons with cardiometabolic risk factors and obesity in children. Environment international, 118, 203-210. Retrieved from https://www.sciencedirect.com/science/article/pii/S0160412018304501

Quek, Y. H., Tam, W. W., Zhang, M. W., & Ho, R. C. (2017). Exploring the association between childhood and adolescent obesity and depression: a meta‐analysis. Obesity Reviews18(7), 742-754.

Rolland-Cachera, M. F., & European Childhood Obesity Group. (2017). Childhood obesity: current definitions and recommendations for their use. International Journal of Pediatric Obesity, 6(5-6), 325-331. Retrieved from https://www.tandfonline.com/doi/abs/10.3109/17477166.2011.607458

Rosenthal, R. J., Morton, J., Brethauer, S., Mattar, S., De Maria, E., Benz, J. K., … & Sterrett, D. (2017). Obesity in America. Surgery for Obesity and Related Diseases, 13(10), 1643-1650. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1550728917303726

Tanya Henry (2018). Adult obesity rates rise in 6 states, exceed 35% in 7. Retrieved from https://www.ama-assn.org/delivering-care/public-health/adult-obesity-rates-rise-6-states-exceed-35-7

Tokgöz, Y., Işık, I. A., Akbari, S., Kume, T., Sayın, O., Erdal, E., & Arslan, N. (2017). Perilipin polymorphisms are risk factors for the development of obesity in adolescents? A case-control study. Lipids in health and disease16(1), 52. https://lipidworld.biomedcentral.com/articles/10.1186/s12944-017-0440-7

Tyson, N., & Frank, M. (2018). Childhood and adolescent obesity definitions as related to BMI, evaluation, and management options. Best Practice & Research Clinical Obstetrics & Gynaecology, 48, 158-164. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1521693417301207

Wang, L., Southerland, J., Wang, K., Bailey, B. A., Alamian, A., Stevens, M. A., & Wang, Y. (2017). Ethnic differences in risk factors for obesity among adults in California, the United States. Journal of obesity, 2017.

Wang, Y., Beydoun, M. A., Min, J., Xue, H., Kaminsky, L. A., & Cheskin, L. J. (2020). Has the prevalence of overweight, obesity, and central obesity leveled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. International Journal of Epidemiology.

Xie, Q., Hao, M. L., Meng, L. B., Zuo, X. Q., Guo, P., Qiu, Y., … & Lei, M. (2019). Effect of eating habits on obesity in adolescents: a study among Chinese college students. Journal of International Medical Research, 0300060519889738. doi.org/10.1177/0300060519889738

Appendix A

Summary of Primary Research Evidence

CitationQuestion or HypothesisTheoretical FoundationResearch Design (include tools) and Sample SizeKey FindingsRecommendations/ImplicationsLevel of Evidence

Legend:

Level I: systematic reviews or meta-analysis Level II:  well-designed Randomized Controlled Trial (RCT)  Level III:  well-designed controlled trials without randomization, quasi-experimental  Level IV:  well-designed case-control and cohort studies  Level V: systematic reviews of descriptive and qualitative studies  Level VI:  single descriptive or qualitative study  Level VII: opinion of authorities and/or reports of expert committees

Appendix B

Summary of Systematic Reviews (SR)

CitationQuestionSearch StrategyInclusion/ Exclusion CriteriaData Extraction and AnalysisKey FindingsRecommendation/ImplicationsLevel of Evidence

Legend:

Level I: systematic reviews or meta-analysis Level II:  well-designed Randomized Controlled Trial (RCT)  Level III:  well-designed controlled trials without randomization, quasi-experimental  Level IV:  well-designed case-control and cohort studies  Level V: systematic reviews of descriptive and qualitative studies  Level VI:  single descriptive or qualitative study  Level VII: opinion of authorities and/or reports of expert committees