Childhood Obesity Prevention:

A Call to Action for the APRN

Sarah M Kinnard RN, BSN-BC

Augustina Manuzak MD, MPH, PhD

Objectives

• Explore the magnitude of the childhood obesity epidemic

• Present a childhood obesity epidemiological model

• Explain the role of the APRN in fighting childhood obesity

• Discuss primary, secondary, and tertiary prevention

• Recognize national, state, and local resources

• Identify recommendations for clinical practice

• Provide suggestions for further epidemiological study

Clinical Definition

• Childhood obesity – a BMI greater than or equal to the 95th percentile for a child of the same age and sex

CDC. (2011). Healthly weight-it’s not a diet, it’s a lifestyle. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Childhood Obesity: A Serious Health

Issue

• Psychosocial problems

• Health Consequences

• Likelihood that obesity in a 4 year-old child continues into adulthood is 20%, increases to 80% by adolescence

• Overweight adolescent children experience increased mortality after the age of 30 years

Prevalence

• More than 16 million children in the U.S. currently suffer from obesity

• Obesity more than doubled in U.S. children and quadrupled in U.S. adolescents in the past 30 years

• Obesity in children (aged 6-11) increased from 7% in 1980 to nearly 18% in 2012

• Obesity in adolescents (aged 12-19) increased from 5% to nearly 21% in 2012

STATE VS. COUNTYLow-Income Children Disproportionately

Affected

2009 State Obesity Prevalence Among Low-Income Children

Aged 2 to 4 Years

2007-2009 County Obesity Prevalence

Among Low-Income ChildrenAged 2 to 4 Years

Source: Centers for Disease Control and Prevention. (2011c). Obesity and extreme obesity rates decline among low-income preschool children. Retrieved from http://www.cdc.gov/obesity/data/childhood.html

Epidemiological Model for Childhood Obesity

Host genetics

age nutrition

knowledge deficit

Causative Agentenergy

dense foods frequent

snackslarge portion

sizessedentary lifestyle

Environment

limited availability of fruits & veggies

fast-food marketing

inaccessibility to safe

parks & bike paths

Role of the APRN

• Physical exam, weight, height, & BMI should be obtained at every wellness visit

• Screen pediatric patients following specific diagnostic recommendations

• Determine the presence and level of risk for obesity-related health complications

• Provides patient and parents with nutritional education and resources

Levels of Prevention

• Primary prevention – focused on maintaining a healthy weight status and can be accomplished by preschool education curriculum to promote healthy eating, physical exercise, and reducing screen time

• Secondary prevention – focused on obtaining a healthy weight status for overweight and obese children by promoting a healthy diet, increasing physical activity, and encouraging family support

• Tertiary Prevention – focused on reducing obesity-related complications and premature death, which include meal replacement, pharmacological therapy, and weight loss surgery

National Resources

Program Organization Description

The Healthy Meals Resource System

Food and Nutrition Information Center, National Agricultural Library, U.S. Department of Agriculture

This online resource system is designed to assist state and local school food service and childcare programs in meeting the Dietary Guidelines for Americans. Web site: https://healthymeals.nal.usda.gov

Let’s Move! White House, Health and Human Services, U.S. Department of Agriculture & Department of Education

This Web site provides ideas on how to improve physical activity and nutrition in schools and at home. It has a section for children with activities and games. Web site: http://www.letsmove.gov/

We Can! Ways to Enhance Children’s Activity & Nutrition

National Heart Lung and Blood Institute, National Institutes of Health

The goal of this program is to support families and communities in helping children maintain a healthy weight. Web site: www.nhlbi.nih.gov/health/public/heart /obesity/wecan/

State & Local Resources

Program Organization Description

Fresh Fruit and Vegetable Program Hawaii State Department of Education, National School Lunch Program

This program target the nutritional needs growing and developing elementary school students, offering fresh fruit and vegetable snacks throughout the school day. Web site: http://hcnp.hawaii.gov/overview/

Hawaii 5-2-1-0 Let’s Go! 

Hawaii Initiative for Childhood Obesity Research and Education

This program promotes healthy lifestyles for children and families. The 5-2-1-0 slogan represents a set of behaviors associated with healthy weight in children; 5 or more fruits and vegetables, no more than 2 hours of screen time, 1 hour or more of moderate activity, and almost no sugar-sweetened beverages daily.Web site: http://www.hawaii5210.com/

Hawaii Nutrition and Physical Activity Coalition 

Hawaii State Department of Health 

This website offers non-bias data and information about community health on the Hawaiian islands.Web site: http://www.npachawaii.org/

Recommendations for Clinical Practice

• Obtain height, weight, and plot BMI on growth chart during every wellness exam

• Assess daily consumption of fruits and vegetables and engagement of at least 60 minutes of moderately active playtime daily.

• Identify vulnerable populations or those at greatest risk for childhood obesity allowing anticipatory guidance and intervention before obesity develops.

• Provide nutritional information and discuss appropriate exercise for the developmental age of the child.

• Discuss any concerns parents may have about their child’s weight with a non-judgmental and blame-free attitude

• Provide parents with national and local resources to encourage and support long-term changes in behaviors.

Recommendations for diagnosing and managing

childhood obesity

Source: Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38(9), 14-21. doi:10.1097/01.NPR.0000433074.22398.e2

Recommended review of systems to detect obesity-

related complications

Source: Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38(9), 14-21. doi:10.1097/01.NPR.0000433074.22398.e2

Suggestions for Further Epidemiological Study

• Obesity in the youth of minority groups

• Obesity in children from a low-socioeconomic status

• Focus on developing effective family-based prevention interventions for minorities

• Development of a standardized measurement for obesity in ethnic groups

Conclusion

• Childhood obesity in children and adolescents has reached epidemic proportions

• Serious health consequences of childhood obesity may lead to comorbid conditions, threating life and increase mortality

• National and State resources are available for childhood obesity

• Considering the APRN may be the sole provider for childhood obesity prevention and treatment in medically underserved areas necessitates knowledge of obesity screening, clinical diagnosis, prevention, treatment guidelines, and management

• Suggestions for further epidemiological study include emphasis on minorities and those from low-socioeconomic status, focus on effective family-based prevention interventions for minorities, and the development of a standardized measurement for ethnic groups

ReferencesAmerican Academy of Pediatrics Committee on Nutrition, Policy Statement. (2003).Prevention of pediatric overweight and obesity. Pediatrics, 112, 424-430. Retrieved from http://pediatrics.aappublications.org/content/112/2/424.full.pdf+html

Behan, D. F., & Cox, S. H. (2010). Obesity and its relation to mortality and morbidity costs. Retrieved from www.soa.org/research-2011-obesity-relation-mortality.htm

Berkowitz, B., & Borchard, M. (2009). Advocating for the prevention of childhood obesity: A call to action for nursing. The Online Journal of Issues in Nursing, 14(1). doi: 10.3912/OJIN.Vol14No1Man02

Centers for Disease Control and Prevention. (2011). Healthy weight-it’s not a diet, it’s a lifestyle. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Centers for Disease Control and Prevention. (2012). Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Retrieved from http://www.cdc.gov/nchs/data/hestat/obesity_child_09_10/obesity_child_09_10.pdf

Centers for Disease Control and Prevention. (2013). Public health genomics: Genomics and health. Retrieved from http://www.cdc.gov/genomics/resources/diseases/obesity/index.htm

Centers for Disease Control and Prevention. (2014). Adolescent and school health: Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm

Choudhary, A. K., Donnelly, L. F., Racadio, J. M., & Strife, J. L. (2007). Disease associated with childhood obesity. American Journal of Roentgenology, 188(4), 1118-1130. Retrieved from http://www.ajronline.org/doi/full/10.2214/AJR.06.0651

ReferencesGonzalez-Suarez, C., Worley, A., Grimmer-Somers, K., & Dones, V. (2009). School-based interventions on childhoodoObesity: A meta-analysis. American Journal of Preventive Medicine, 37(5), 418-427. doi:10.1016/j.amepre.2009.07.012

Hawaii Department of Health. (2012). State of Hawaii primary care needs assessment data book 2012. Retrieved from http://health.hawaii.gov/about/files/2013/06/pcna2012databook.pdf

Hoelscher, D. M., Kierk, S., Ritchie, L. & Cunningham-Sabo, L. (2013). Position of the Academy of Nutrition and Dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity. Academy of Nutrition and Dietetics, 113(10), 1375-1394. Retrieved from http://www.seen.es/docs/apartados/834/Pediatric%20overweight%20and%20obesity%202013.pdf

Karnik, S., & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal Of Preventive Medicine, 3(1), 1-7. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278864/

Novotny, R., Oshiro, C., & Wilkens, L. (2013). Prevalence of childhood obesity among young multiethnic children from a health maintenance organization in Hawaii. Childhood Obesity (Print), 9(1), 35-42. doi:10.1089/chi.2012.0103

Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38(9), 14-21. doi:10.1097/01.NPR.0000433074.22398.e2