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Synthesis Worksheet

1. What is the information (existing findings) that led researchers to conduct this particular study?

Article 1: Ijaz et al. (2021) found existing evidence from previous studies showing that there are certain
school-based interventions that could be used to prevent obesity among children. However, it was not
clear how and which interventions worked best. A lot of information was not available such as the age
of children and the effectiveness of existing interventions. The researchers thus conducted their study to
identify the interventions that could be used to prevent obesity in primary school children as well as
their effectiveness in different environments.

Article 2: Ferruzzi et al. (2021) were led into conducting their research by existing research showing
that several comorbidities are associated with pediatric obesity and overweight. Given the occurrence of
the Covid 19 pandemic, the researchers found childhood obesity to also be a problem among overweight
children, and this motivated the researchers to conduct the study.

Article 3: Rambaran et al. (2021) found data showing the rise in prevalence of obesity among school-
going children worldwide. They found that trends in the prevalence of obesity in children were missing
in available data, and this led them to conduct the study to find out the trends in childhood obesity over
the last two decades.

Article 4: Angawi & Gaissi (2021) found existing research on various interventions being implemented
across developed and developing countries with the aim to prevent childhood obesity. The two
researchers then conducted a systematic review with the aim of evaluating, synthesizing, and putting

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together all these interventions and came up with findings on how these can be combined and their
effectiveness enhanced in both developed and developing nations.

Article 5: Truong et al. (2021) found that although a lot of studies have been conducted on childhood
obesity, it still remains a very challenging condition to manage. Existing studies do not reveal much
progress in the strategies that can be used to effectively manage childhood obesity. They found studies
showing that physiotherapists have the potential to manage obesity among children. This is because they
are experts in physical activity and movement. However, it is not clear what their role is in the
management of childhood obesity as there lack of guidelines that are specific to physiotherapy. The
researchers then conducted a study to provide guidelines that are specific to physiotherapy and
supported by evidence showing physiotherapists what they can do to manage obesity among children.

Synthesis: The background studies that motivated the researchers in all five articles to show one thing in
common, the acknowledgment that childhood obesity is a global problem. All countries, both developed
and developing, struggle with obesity among children. It is also clear that obesity in childhood, in most
cases, leads to adult obesity, and this makes the problem serious as it is associated with other health
issues such as heart diseases and diabetes.

2. How did the researchers describe the purpose/goal of the current study?

Article 1: Ijaz et al. (2021) conducted the study with the aim of establishing and understanding the
mechanistic and contextual factors linked with the outcome of studies conducted on the implementation
of school-based interventions to prevent childhood obesity. The researchers’ goals were influenced by

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the Cochrane review on the viability of implementing interventions in primary schools within the UK to
help prevent obesity among children.

Article 2: The purpose of Ferruzzi et al. (2021) in conducting the study was t use a holistic approach in
identifying the relationship between childhood obesity and Covid-19.

Article 3: the purpose of the study conducted by Rambaran et al. (2021) was to explore trends, their
similarities, and differences in the prevalence of childhood obesity in Trinidad and Tobago.

Article 4: The purpose of the study was to find out the effectiveness of multi-setting and multipronged
strategies in the prevention of obesity among children. Angawi & Gaissi (2021) aimed at finding out the
effectiveness of school-based interventions in the prevention of obesity in children, as well as how their
effectiveness was affected if combined with other interventions implemented in non-school settings.

Article 5: Truong et al. (2021) describe the purpose of their study as to guide physiotherapists on how to
use evidence-based management of childhood obesity. The aimed at using existing literature,
synthesizing it, critically appraising it, and synthesizing the findings with the aim of providing
guidelines on how physiotherapists can use their expertise to manage obesity among children.

Synthesis: The researchers in all five articles set their goals based on gaps in the existing literature. In
some, the researchers’ aims were influenced by a need to establish how existing studies in different
countries can be combined to provide a comprehensive account of other studies conducted on the
prevention and management of obesity among children.

3. What methods did the researchers use to conduct the study?

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Article 1: The researchers conducted a realist review. The study was underpinned by the Realist and
Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES). The realist synthesis is a
relatively new method to address questions raised in the study. The method enabled the researchers to
present new insights from the study, and this would not have been possible had they used the traditional
meta-analysis method.

Article 2: The researchers conducted a quasi-review. They performed a systematic literature search
through PubMed databases and Cochrane library. Two authors independently used rate stud quality and
data fields to extract data from the databases. They used two keywords in the search; Covid-19 and
obesity, with a particular focus on pediatric patients. They also looked for obesity in adulthood so that
they could compare the information.

Article 3: The researchers used cross-sectional, multisite methods to conduct the study. It was a
primary-school-based study. The study extended from January 2018 to May of the same year. The
sample comprised of 3080 children from here countries with the highest population. The countries were
Trinidad and Tobago, Jamaica, and Belize. The researchers had clusters, and the aim was to get a sample
of 100 children from every four or five clusters.

Article 4: The researchers conducted a systematic and electronic search on data related to setting-based
interventions associated with preventing or managing childhood obesity.

Article 5: A scoping review was conducted. The researchers looked up existing literature available up to
May 2020. They accessed data from four databases, namely Medline, Embase, CINAHL, and PubMed.

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Synthesis: The researchers used various methods in conducting the study. There are some who
conducted their study by searching through existing literature and synthesizing data provided by
scholars in previous studies. They did so using various methods. For example, Ijaz et al. (2021)
conducted a realist review, while Truong et al. (2021) conducted a scoping review. However, there are
also researchers who used other methods, such as Rambaran et al. (2021), who conducted a cross-
sectional multi-setting study.

4. What were the results/findings?

Article 1: The researchers found that higher parental academic achievement, older age, and female sex
were factors that positively influenced the effectiveness of interventions aimed at preventing and
managing childhood obesity. Girls benefited more from the interventions due to the influence of social
norms on body image. Parents with higher educational attainment guided their children better towards
engaging in healthy practices, and this helped prevent obesity.

Article 2: Evidence gathered during the study showed that when Covid-19 struck, measures such as
quarantine were put in place. During quarantine, children engaged in reduced physical activity and had a
prolonged exposure to screen time. Additionally, children’s sleep patterns were disrupted, and they had
more access to less favorable diets. Such negative effects of Covid-19 were much worse on children
who were already overweight or obese even before the pandemic struck. The researchers found that
obesity is a risk factor for covid-19.

Article 3: The researchers found that all the ten Caribbean territories had a high prevalence of obesity
and overweight children. Dominica showed the highest rates of childhood obesity. The high rates

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corresponded with increased sedentary time and a decline in physical activity among children between
2011 and 2017.

Article 4: Researchers found evidence supporting the effectiveness of school-based and non-school-
based interventions in the prevention of childhood obesity. The results highlighted the importance of
combining these interventions to avoid obesity in children and adolescents.

Article 5: The researchers found that the interventions supported by evidence by previous studies
included quantitative focused physical activity, qualitative focused physical activity, and
multicomponent interventions. The general trend for the involvement of physiotherapists in managing
obesity among children appeared to favor two main interventions, and the first one is the
multicomponent interventions. The researchers found that implementing a variety of components with
the involvement of parents and modification of the environment and combined with quantitative
physical activity interventions effectively led to desirable changes. The approaches, with the focus being
bodily movements, consistently demonstrated desirable changes among children and thus proven
effective in managing obesity among children.

Synthesis: Social norms, sedentary lifestyles, and access to unhealthy foods are some of the factors
identified to be linked to childhood obesity. The results/findings of these studies were not all similar as
the aims also varied. For instance, Truong et al. (2021) found that physiotherapists could implement a
multicomponent of approaches in their attempts to manage obesity. The researchers provided an
evidence-based guide to physiotherapists on how they could better help children achieve healthy
weights.

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5. What conclusions did the researchers reach about the results?

Article 1: The researchers conclude that sufficient interventions combined with modifications of the
school environment would help achieve the desired outcomes, which entail preventing and managing
obesity in children.

Article 2: The study concludes that COVID-19 could have an important indirect impact on the physical
and mental health of children and adolescents. During quarantine, children were less active.

Article 3: The study concludes that policymakers need to employ different policies to tackle the
problem of child obesity. Increasing the national awareness on childhood obesity as well as ensuring that
beneficial lifestyle changes are implemented can help ensure that the prevalence of childhood obesity is
minimized.

Article 4: The research concludes that school-based activities that incorporate both diet and physical
activity can help in reducing childhood obesity. Interventions should also focus on creating ideal home
environments.

Article 5: The authors conclude that an increase in the level of physical activity in children can help in
achieving the desired health outcomes. A multicomponent intervention that focuses on physical activity,
self-esteem, and sedentary measures can help in achieving the desired behavior change.

Synthesis: All articles indicate that physical activity and diet can help eliminate the problem of
childhood obesity.

6. What limitations/concerns did the researchers note regarding their studies?

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Article 1: The main limitation of the study identified by the authors is the focus on traditional behavior
change at individual levels as well environmental or policy interventions that focus on wide
determinants of health. The evidence base is limited by the two major centers of attention.

Article 2: The study was majorly a quasi-review of existing data on childhood obesity. The implication
of this is that it does not allow conclusions to be drawn between COVID-19 and pediatric obesity.
Instead, the study examines the potential risks associated with both COVID-19 and pediatric obesity.
Another key limitation identified by the authors is time. The research relied on data available up to
October 2020. Some crucial data were excluded from the study. Certain waves of COVID-19 were not
included in the research. The failure to include all the data limits the findings of the research.

Article 3: The authors indicate that the sampling design was a major limitation of the study. The sample
used in each country was not nationally representative. The implication is that it did not provide regional
estimates that are detailed. Further, the study excluded children with major medical illnesses. The
exclusion of these children may have affected the conclusions of the research. The analysis of Trinidad
and Tobago did not have sufficient methodologies and demographics.

Article 4: The randomized controlled trials had a variation in study parameters. The variations were
evident in the length of follow-up and type of outcome. Comparing the research across various studies
was difficult. The research relied on studies published in the English language. As a result, some crucial
studies may have been omitted. Using only studies that are published in English introduces a publication
bias.

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Article 5: One limitation of the study revolves around the primary studies overlap that may have
occurred as a result of the wide inclusion umbrella of reviews. The researchers also acknowledge that
bias in the interpretation of results may have occurred.

Synthesis: All articles indicate that the weaknesses are drawn in the data collection methods applied.

7. What further research did the researchers recommend?

Article 1: The study recommends full cost reporting of different interventions to childhood obesity. Full
cost reporting can help analyze different interventions as well as the returns of different interventions.
Full cost reporting can also aid in the selection of the intervention that can best address the problem of
childhood obesity. A breakdown of the cost per intervention is also necessary to aid in better decision-
making.

Article 2: The article recommends further research into the different waves of COVID-19. More studies
are also needed to analyze data from a larger population. The authors note that they relied on a small
population, and this may create limitations on their findings. More studies are needed to ensure that the
risks are qualified as well as define the risks among children and adolescents.

Article 3: The study recommends the use of representative national surveys. The use of national surveys
can help in better understanding the problem of childhood obesity. In addition, national surveys can help
in analyzing the effectiveness of national action plans on obesity. Trends can be identified, and steps can
be taken to reduce the prevalence of childhood obesity.

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Article 4: The research recommends further research that utilizes strong study designs. Further research
grounded in theory should be used to help understand the problem of obesity in children. The studies
should be conducted in non-school settings to help gain a better understanding of childhood obesity.

Article 5: Further research should be inclined towards systematic reviews and meta-analyses. Such
studies can help gain a better understanding of childhood obesity. Systematic reviews may add more
value to the understanding of childhood obesity and can facilitate the selection of interventions.

Synthesis: The articles recommend different areas of further research.

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References

Angawi, K., & Gaissi, A. (2021). Systematic Review of Setting-Based Interventions for Preventing Childhood
Obesity. BioMed Research International, 1–10. https://doi.org/10.1155/2021/4477534

Ferruzzi, A., Gasparini, L., Pietrobelli, A., Denina, M., Rigotti, E., & Piacentini, G. (2021). Childhood obesity
and SARS-CoV2: dangerous liaisons. Child & Adolescent Obesity (2574254X), 4(1), 89–97.
https://doi.org/10.1080/2574254X.2021.1883393

Ijaz, S., Nobles, J., Johnson, L., Moore, T., Savović, J., & Jago, R. (2021). Preventing Childhood Obesity in
Primary Schools: A Realist Review from UK Perspective. International Journal of Environmental
Research and Public Health, 18(24). https://doi.org/10.3390/ijerph182413395

Rambaran, K., Teelucksingh, S., Gowrie Sankar, S., Boyne, M., Xuereb, G., Giorgetti, A., & Zimmermann, M.
B. (2021). High prevalence of childhood overweight and obesity in ten Caribbean countries: 2018 cross-
sectional data and a narrative review of trends in Trinidad and Tobago. Child & Adolescent Obesity
(2574254X), 4(1), 23–36. https://doi.org/10.1080/2574254X.2020.1847632

Truong, K., Park, S., Tsiros, M. D., & Milne, N. (2021). Physiotherapy and related management for childhood
obesity: A systematic scoping review. PLoS ONE, 16(6), 1–37.
https://doi.org/10.1371/journal.pone.0252572