Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

Childhood obesity, one of the most current issues of health education today, poses short and long-term effects on health and wellness. According to the Center for Disease Control (CDC) (2011) the numbers have more than tripled in the past 30 years, with more than 1/3 of children and adolescents being overweight or obese. CDC defines overweight in children by a body mass index (BMI) at or above the 85th and lower than the 95th percentile and obesity is defined as a BMI at or above the 95th percentile. Risk factors such as cardiovascular disease, high cholesterol, high blood pressure, prediabetes, bone and joint problems, sleep apnea, and psychological problems such as stigmatization and poor self-esteem increase for children with obesity (Adolescent and School Health, 2011). This population is 70-80% more likely to become overweight or obese as adults which enhances the risk of an obesity-related diagnosis (Haboush, Phebus, Ashby, Zaikina-Montgomery, & Kindig, 2011). In addition to clinical conditions, obesity significantly impacts physical, social, emotional, and school domains (Riazie, Shakoor, Dundas, Eiser, & McKenzie, 2010). These struggles experienced as children may lead to decreased self-esteem, self-worth, and confidence. Further, these experiences put individuals at risk for increased anxiety and sadness as adults, which may lead to mental illness or elevated engagement in risky behaviors (Sanderson et al, 2011;Strauss, 2000). This condition is an epidemic and poses economic concerns as well. According to a study in 2009 published in Medical News Today, 147 billion dollars is spent annually on the healthcare cost of obesity (Paddock, 2009). Regardless of a child’s ethnic background, economic circumstance, or environmental setting, obesity is of soaring concern.

Occupational therapists (OT) employed in the school system typically see children receiving special education services as directed by the Individuals with Disability Act (IDEA). School OTs caseloads consist of children who have been referred to special education by a parent or teacher, and then evaluated by an Individualized Education Plan (IEP) team, which includes an OT (Bober & Corbett, 2011). Goals include: academic and non-acedemic outcomes in social skills, math, reading, writing, recess play, self-help skills, participation in meaningful activities, and transitions (Bober & Corbett, 2011). Interventions commonly focus on handwriting, sensory-awareness/processing, gross/fine motor skills, and perceptual abilities (Barnes, Beck, Vogel, Grice, & Murphy, 2003). Although it is not written in the scope of OT practice to create prevention programs, specifically obesity in the school setting, OTs have the skills, imaginative tools, program development training, and holistic viewpoints of individuals to do so. As mentioned in the newest OT Obesity Position Paper, OTs voluminous areas of skills contribute to the practice of obesity through prevention and intervention techniques including diet and nutrition, exercise, behaviour modification and lifestyle changes (Clark, Reingold, Salles-Jordan, 2011). The purpose of this critically appraised topic is to determine the potential effectiveness that occupational therapy could have in preventing childhood obesity, particularly in the school setting.

Clinical Question

What is the effectiveness of occupational therapy on children with obesity in the school setting?

Clinical Bottom Line

Children with obesity are at risk of feeling anguish from physical taunting and social stigmatization which may result in educational deficits and emotional uncertainties. This increases the risk for severe clinical, psychosocial, and mental illness in his/her future. In addition, these diagnoses result in millions of dollars in health expenses. Research shows that children as young as 3 years old may be at risk for obesity. Further research found that the emotional domains of children with obesity during the age of increasing autonomy have significantly poorer self-scores than those of normal-weight. OTs have knowledge in psychosocial, physical, environmental, and spiritual factors that allow them to effectively treat this clientele. School is where most learning is structured, planned, and executed and seems to be the most ideal location for acquiring good eating and exercise habits, therefore preventing social isolation, and the risk of future mental and psychosocial issues. With team collaboration and more formal education for OTs working with children that may be suffering secondary factors of obesity (e.g. emotional disturbance) OTs have the potential to create programs for the schools, with the goal of creating healthy habits and routines through education, play, and peer interaction, and in turn, benefit the occupational engagement of children.