Running Head: THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 1

The Relationship Between a Pediatric Patient's Ethnicity and Risk of Developing Obesity

Rahi Shah

Wheeler High School

THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 2

Table of Contents

Rationale of Study 4

Concept Map 5

Chapter 1: Introduction 6

Purpose of the Study 6

General Context of the Study 6

Guiding Questions 6

Hypotheses 6

Definition of Key Terms 7

Assumptions 8

Limitations and ​Delimitations 8

Significance of Study 9

Chapter 2: Literature Review 10

Chapter 3: Methodology 14

Conceptual and theoretical framework 14

Type of design and its underlying assumptions 14

Role of the researcher 15

Selection and description of the site and participants 15

Data Collection Strategies 16

THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 3

Pilot Study 16

Changed based on Pilot Study 16

Actual Study 16

Data-analysis strategies 17

Methods of ensuring validity and reliability 19

Management plan, timeline, feasibility 20

References 21
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Rationale of Study

Obesity, the condition of being excessively overweight, is a rising issue in the United

States. Although it is not a new concept, the word ‘obese’ has found a new meaning into the lives

of many people: normal. Obesity rates have been at a steady increase for many years, but today

there are more cases than ever. Obesity indicators are especially increasing globally among the

pediatric population. Most cases of obesity in the United States are a result of the increased

consumption of fast food as well as the now growing sedentary lifestyle in America. According

to Pacheco et al. (2017), the consequences of childhood and adolescent obesity are extensive,

including both medical and psychosocial comorbidities, as well as increases the risk of

cardiovascular disease and metabolic disorders later in life (Pacheco, Blanco, Burrows, Reyes,

Lozoff, & Gahagan, 2017). Ethnicity is the state of belonging to a social group that has common

cultural traditions; traditions include foods, lifestyle, celebrations, etc. Because people of the

same ethnic group tend to have the same lifestyle, they are likely to have similar average blood

pressure rates, height, and susceptibility to other diseases, such as diabetes and obesity rates.
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THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 6

Chapter 1: Introduction

Purpose of the Study

The purpose of this longitudinal case study is to determine if there is a statistically

significant relationship between a patient’s ethnicity and his or her risk for obesity.

General Context of the Study

This study is in the healthcare sciences field, which is crucial to human health. Obesity is

a rising problem today, especially in pediatrics. The rate of pediatric obesity has gone up the past

decade and continuously is growing. The United States is home to many different ethnic groups

with different traditions and lifestyles. All three of these have some sort of impact on one

another. This study is designed to look at the effects of and relationships among ethnicity and

obesity rates (Pacheco, Blanco, Burrows, Reyes, Lozoff, & Gahagan, 2017, 2018).

Guiding Questions

Q1. ​How is obesity measured in the United States?

Q2.​​ How does ethnicity and public policy affect obesity rates in the United States?

Q3.​​ ​Based on the patients’ ethnicity, what are the risks of obesity?

Hypotheses

H1. ​If a person's body weight is at least 20% higher than it should be, he or she is

considered obese. For patients younger than 17 years of age, the Body Mass Index (BMI)

should not be above the 87th percentile. Obesity is caused by many factors such as:

genetics, diet and nutrition, lifestyle, certain medications, and insulin problems. (The

MNT editorial team, 2016).

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H2. ​Government regulations and laws, such as Michelle Obama’s health initiatives, have

played a role in the rate of obesity of a country (decreasing rates in this case). Cultural

aspects such as the foods citizens eat and lifestyle that the they live also can affect obesity

rates (CDC, 2015).

H3. ​The ethnicity of the patient and will have a statistically significant relationship with

the obesity of the patient. The independent variable is the ethnicity of the patient, and the

dependent variable is the obesity rate.

Definition of Key Terms And Acronyms:

1. Pediatrics: A branch of medicine dealing with children under the age of 18 (Frontini,

Moreira, & Canavarro, 2016)

2. Body Mass Index: An index of that is commonly used to classify underweight,

overweight and obesity. It is defined as the weight in kilograms divided by the square of

the height in meters (kg/m​2​) (Teder, Morelius, Nordwall, Bolme, Ekberg, Wilhelm, &

Timpka, 2013).

3. Ethnicity: Shared cultural practices, perspectives, and distinctions that set apart one group

of people from another. Most practices and places define ethnicity has being of

Latin/Hispanic origin or not (Carof, 2017).

4. Obesity: Obesity is excessive amounts of fat on the body with a body mass index of

20 kg/m^2 or higher. For children, it is measured by percentile, and being above the 87th

percentile is considered obese (Lutz, Mazur, & Litch, 2015, p. 596).

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5. Quality of Life: A form of measurement used to assess the impact that health has on

things such as life expectancy and way of living, as well as possible causes of death

(Frontini, Moreira, & Canavarro, 2016).

6. Health Insurance Portability and Accountability Act: provides data privacy and security

provisions for safeguarding medical information (“HIPAA”, 2018)

7. CPNP: Certified Pediatric Nurse Practitioner

8. Provider: A medical professional who is considered a doctor of medicine

9. BMI: Body Mass Index

10. HIPAA: Health Insurance Portability and Accountability Act

11. QoL: Quality of Life

Assumptions

● BMI is an accurate measure of obesity.

● Each patient’s data is independent from one another.

● Regression Test:

a. A large sample size is used

b. The data is representative of the sample

● Obesity is classified as anything above the 87th BMI percentile.

● A child’s ethnicity is the same as what the parent identifies themself as.

Delimitations and Limitations

● The patients’ ages range from six to sixteen years old.

● The variables are restricted to ethnicity, height, weight, and BMI percentile.

● Only patient data since the day the internship started can be used.
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● There is no guarantee that patients will listen to the provider on how to lose

weight/become healthier.

● The researcher cannot create a control group for this study..

● The researchers will not include people of mixed ethnicities in the study.

Significance of Study

The significance of this study is to examine relationship between ethnicity and obesity to

give researchers further knowledge on how the two are related. This can help health

professionals understand how and when to start treatment options. It is also beneficial to the

patients because some ethnicital traditions may actually harm the body and it is important for

them to know how to keep themselves healthy. This study focuses on the relationship of ethnicity

and obesity with children in specific, who have become more susceptible to obesity. With

knowledge on the relationship between ethnicity and obesity, the children can be healthier,

leading to many preventable doctor visits to be gone.

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Chapter 2: Literature Review

Obesity is abnormal or excessive fat accumulation in the body. For children, it is

measured by Body Mass Index (BMI) percentile. Patients younger than 17 years of age are

considered obese if their BMI is above the 87th percentile. Obesity is caused by many factors

such as genetics, diet and nutrition, lifestyle, certain medications, and insulin problems (Conway

et al., 2018). Being obese can lead to many complications in the future, such as the development

of diabetes. According to Conway et al. (2018), there is a direct correlation between high BMI

and incident of diabetes (Conway et al., 2018). Recently, children have become more

knowledgeable about healthy lifestyles and the basic understanding of diabetes and obesity. A

study by Surani et al. (2018) sought to discover how much knowledge children have on obesity

and its effects. The study found that the children did better the second time the test was taken,

after learning key points and information about nutritional health. (Surani et al., 2018).

Both parents and children view obesity differently. In a study by Koning et al. (2018), the

level of agreement between parents and child reports on lifestyles and health related behaviors

was examined. The researchers measured the children’s height and weight over a three week

period by providing questionnaires to both the child and parent and determined the level of

agreement for five important health related behaviors: breakfast consumption, family dinner,

outdoor play time, transportation to and from school, and time spent on electronic devices. On

average, children did not view bad behaviors-such as watching excessive TV-as unhealthy

behaviors. In matters such as health and care, there can be disagreements between the behaviors

reported by the parents and the children themselves (Koning et al., 2018).
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Parenting style can also be a cause of a child’s obesity and weight gain. More children

whose mothers have permissive parenting style are obese than other children (Frontini, Moreira,

& Canavarro, 2016). Children with lower levels of quality of life (QoL) also have higher rates of

obesity (Frontini et al., 2016). Lifestyle can impact to a child’s BMI. From a study done on

children to determine the effects of changing lifestyles, the results showed that the children’s

weight decreased significantly along with parent reports of the children being more physically

active and eating more nutritionally (Teder et al., 2013). Improvements made to a child’s

lifestyle can help them lose weight and lower his or her chances of developing obesity in the

future.

Public policies are different based on the country, especially in the United States. A 2010

policy, the Healthy, Hunger-Free Kids Act (HHFKA) is one such policy. According to Vaudrin,

Lloyd, Yedidia, Todd, & Ohri-Vachaspati (2018), this policy saw change in the foods that

children eat at school and strengthened nutritional standards (Vaudrin et al., 2018). The

implementation of a food and physical activity policy has also affected obesity rates. A study

involving 122 public and private elementary schools in Mexico found that school-implemented

activities became very helpful in getting school children more active and healthy (Theodore et

al., 2018). The two different public policies between the American School System and the

Mexican School system yielded different results. The HHFKA didn’t yield high participation

rates, and according to Essington and Hertelendy (2016), wasted an estimated $432,349 in one

school year with continuously increasing child obesity rates (Essington & Hertelendy, 2016).

However, the Mexican Ministry of Education got children to eat healthier and be more active,

helping child obesity rates decline (Theodore et al., 2018). Policies in the United States
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specifically have been engineered to assist in weight loss in children, but it cannot be a 100

percent success due to different ethnic groups’ diets, customs and traditions, and social lifestyles.

However, many of the public policies have helped decrease obesity rates in children and

adolescents.

Different ethnicities and cultures also play a role in a child’s obesity. In Wolaita Sodo

Town, Southern Ethiopia, many families and students had access to teff-the staple food of the

country. According to Teferi, Atomssa, and Mekonnen (2018), “a majority of the 680 families

had access to proper fruits one day a week, and 207 adolescents had fruits three or more times a

week” (p. 8). While most children in Wolaita Sodo Town, Southern Ethiopia were suffering from

undernutrition, there was a similar prevalence of overnutrition. The study concluded that there

was a significant difference nutritional availability and the weights of the children in Southern

Ethiopia (Tefferi et al., 2018).

In a study by Carof (2017) with the purpose to “seize the national variability of the

physical norms of overweight and obesity by comparing France, England, and Germany” (p. 57),

numerous studies of the views of the citizens of these countries were analyzed, as well as food

and physical activity patterns to determine if there is a relationship between how the country

views its obese people and if the customs of the country play a role on obesity (Carof, 2017). The

study found that gender, age, socioeconomic background, or immigrant origin were important

factors in learning to understand that there are many common and uncommon features about

weight, body, and food in the different countries. Each country has a different outlook on

obesity. In France, people view being slightly overweight as not aesthetically pleasing while in
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Germany, being overweight is less problematic. In England, people associate being obese with

not eating proper foods or playing sports (Carof, 2017).

In a recent 2017 study done by Nelson et al. (2017), racial and ethnic differences were

measured to see differences in how Body Mass Index (BMI) would change based on the ethnic

and family lifestyles. The research studied 1,461 Caucasian, Hispanic, African American, and

Asian children, Caucasians had lower BMIs in average compared to other ethnicities, and the

intervention program did not cause a large change. (-.15 percent change). African American

children exposed to the program showed a greater decrease in BMI (-1.38 percent change) than

other children did. Children of all ethnicities went through the same intervention program,

regardless of what their natural household traditions might be, and drastic changes were reported.

African Americans had the largest decrease in BMI, while Hispanics had the smallest decrease in

BMI (-.03 percent change) (Nelson et al., 2018). The differing rates between Caucasians’,

Asians’, Africans’, and Hispanics’ weight rates and average BMI percentile indicate that not all

ethnicities respond to the same treatment or program.

According to the various literature and studies analyzed, ethnic differences in the

effectiveness of a multisector childhood obesity prevention intervention by Nelson et al. (2018)

most corresponds to my study and research. This study specifically measures relevant data to the

research project. It is the gold standard for the ongoing research project and allows for the

researcher to correctly identify relationships. This study also looks at lifestyle changes and the

effects of that on weight levels, which is important in identifying the proper relationship between

obesity and ethnicity (Nelson et al., 2018).

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Chapter 3: Methodology

Conceptual and Theoretical Framework

In order to determine if there is a statistical significance between ethnicity and obesity

rates in the pediatric patients, the researcher must first collect data about causes of obesity and

different ethnicities. The researcher will then observe and record each patient’s ethnicity, age,

height, weight, and BMI percentage using the patient growth chart for the current visit. The

researcher will also record the frequency of each ethnicity that enters the facility. With pediatric

patients that are obese (87th percentile), the provider, a Certified Pediatric Nurse Practitioner,

will offer suggestions about lifestyle changes and methods to prove the weight and overall health

of the patient. Over the three week course between visits, the patients will follow the provider’s

guidelines and attempt to improve their weight. During the standard three week check-up, the

patients will have a weight check to measure the difference in weights between the two visits.

Again, the researcher will observe the new height, weight, and BMI percentage and compare it to

the baseline set of data. At the end, the mean BMI of the primary visit will be compared to the

mean BMI of the second visit to determine the average change in weight. Using a chi-squared

goodness of fit test, the researcher will either support or reject the original hypothesis.

Type of design and its underlying assumptions

This design is going to be a qualitative longitudinal case study due to analyzing different

data of pediatric patients over a period of time. The study will utilize both inferential and

descriptive statistics due to using a sample statistics to infer relationships of the population

parameters as well as describing data using measures of center such as the mean. Underlying

assumptions from this design include:

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- The patients will correctly follow the provider’s lifestyle change plans to help assist in

controlling their weight.

- Each patient’s weight is independent from one another.

Role of the researcher (including qualifications and assumptions)

The role of the researcher is to observe the patients and identify whether there is

relationship between the patients’ ethnicity and their obesity rates. The researcher will assist in

monitoring the patient’s charts. Qualifications of the researcher include signed HIPAA forms

indicating that the researcher has gone through the proper training to work with patients and read

their charts and is a certified emergency medical responder, indicating the researcher’s

knowledge in the medical field. The researcher is also backed by a Certified Pediatric Nurse

Practitioner who supervises and guides the research to collect proper data. Assumptions about

the researcher include:

- The researcher has done the proper research on the question before beginning the study.

- The researcher is backed by a professional who has knowledge on the research topic.

Selection and description of the site and participants

The researchers will conduct this study at Nuestros Niños Our Kids Pediatrics. It is a

small pediatric clinic located in Marietta, GA where patients’ ages range from newborn to age

17. Many patients come in for a variety of reasons, including yearly well-checks, breathing

problems, sicknesses, and weight checks. The participants will be all patients that are viewed by

the provider during the researcher’s time at the internship until the last secondary visits reach the

last week of the researcher’s internship. The researcher does not have the exact number of

patients yet, as the number of patients will increase as the study continues.
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Data Collection Strategies

I. Pilot Study

This research topic will utilize data using a nominal scale because the data will be

categorized into labels such as ‘Obese’ without any quantitative data. Descriptive statistics will

be used when collecting and analyzing data because the researcher is measuring one single

variable-’Is obesity present?’. Measures of center will help organize the data and make it more

concise so testing using a regression test may be done. The hypothesis is stated below:

The ethnicity of the patient will have a statistically significant relationship with the

obesity of the patient or risk of developing obesity.

II. Changed based on Pilot Study

Changes made on the pilot study include going from a single variable to having two

variables in the research. Also, the research study will not only utilize descriptive statistics, but

also inferential statistics to test the hypothesis to infer relationships of the population parameters.

The testing to conclude data collection and analyzation will also not be a regression test, but a

chi-squared test to measure statistical significance.

III. Actual Study

The type of data that the researcher will use in this study is nominal data because the

subjects are allocated to different categories. For example each patient is categorized by

ethnicity, and further categorized by their BMI to identify the percentages of obesity in each

ethnicity. Both inferential statistics and descriptive statistics will be utilized because the

researcher is using sample statistics to infer relationships of the population parameters by

hypothesis testing and correlation regression testing (inferential). The researcher will also
THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 17

describe the data using numbers, charts, and graphs, as well as measures of center to analyze the

data. At the end, a description of the entire group for which the numbers were obtained will be

portrayed. The hypothesis is stated below:

Hypothesis: The ethnicity of the patient (independent variable) will have a

statistically significant relationship with the obesity rates (dependent variable) of

the patient.

Data-analysis strategies

To analyze the collected data, the researcher will use a chi-squared goodness of fit test.

This test will be able to show the statistical significance between ethnicity and obesity rates,

allowing for either a support or rejection of the hypothesis. To do this test, the researcher will

calculate the expected counts using the actual observed counts and dividing it by the total

number of patients. To calculate the chi-squared value and p value, the researcher will use the

following formula:

2
∑ (observed−expected)
expected

The researcher will also calculate the degrees of freedom by multiplying the number of rows

minus one by the number of columns minus one and use the chi-squared chart to obtain the

significance. A blank copy of the tables the researcher will use to collect data is provided below:
THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 18

ASP 1: Individual Patient Data Table

Table 1

Age Gender Ethnicity Weight Height (in.) BMI & Percentile

(lbs)

This data table will record each individual patient’s data, and will be adjusted to fit the correct

number of patients.
THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 19

ASP 1: BMIs for different ethnicity patients

Table 2

Caucasian African Asian Hispanic

American

Obese

(BMI>87th

percentile)

Not Obese

(BMI<87th

percentile)

Frequency of

ethnicity

This data table will be used to calculate the total number of patients in each category

Methods of ensuring validity and reliability

One method of ensuring validity throughout this study is that the researcher will be

backed by a certified pediatric nurse practitioner, so that face validity will be ensured throughout

this study. Referencing the patient chart program that allows for the researcher to collect the data

will account for content validity. This program is updated frequently, making sure all patient data

is up to date. Analyzing the data and results and comparing it to other peer-reviewed studies of

the same nature ensures construct validity. One method of ensuring reliability throughout this

study is by collecting the patient data the same way, including proper rounding rules that are to
THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 20

be followed throughout. Another method of ensuring reliability is to restrict data to current and

future visits only, giving the researcher the most current data to look at. Other methods of

ensuring reliability and validity include following all written protocol strictly so that desirable

results are gained and to perform the study in the allocated time slot given.

Management plan, timeline, feasibility

The researcher will manage how the study takes place as well as the timeline of the study.

The CPNP will assist the researcher by making sure the researcher is properly conducting the

study. It is the researcher’s job to follow the timeline for conducting the research and getting the

data required for analysis and testing. As per the timeline that the researcher will follow, there

will be a five to six week period in which the researcher will collect data for both the first visit

and second visit of the patient until the final patient has come in for their secondary check-up.

This research topic is replicable, especially since there is a basic methodology that future

researchers may reproduce the study. This study can also be performed in different cities within

the United States, as well as countries outside of the United States. The study provides suitable

data regarding obesity rates and ethnicity and also creates a framework for further research on

the subject.
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THE RELATIONSHIP BETWEEN ETHNICITY AND OBESITY 23

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