Childhood Obesity: What can be done?

The growing epidemic of childhood obesity has become a recent public health crisis for our country. Because childhood obesity can lead to adverse health outcomes such as increased blood pressure, type two diabetes, and orthopedic complications, nurses must come together to find a solution. Nurses can aid in combating this concern by implementing early identification measures, assessing parental perception, and providing family education.
Over the last ten years the incidence of childhood obesity has greatly increased for all ages and ethnicities. The primary cause for this increase is the imbalance between energy intake and energy expenditure (Nicholas & Livingston, 2002). America’s sedentary lifestyle and poor nutritional habits have contributed to this energy imbalance. Many obese children will suffer from social isolation, poor body image, and depression if proper intervention does not occur (Berry, Galasson, Melkus, & Grey, 2004). It is imperative that nurses identify children at risk and take action to assist them in living a healthier lifestyle.
A complete assessment needs to be taken by the registered nurse (RN) before planning interventions for an obese child. Well child check-ups and yearly child physicals at a family or pediatric office presents an optimal time for assessment. It should consist of a family history (heart disease, diabetes, obesity, hypertension, hyperlipidemia, pancreatic disorders, and musculoskeletal disorders), a review of the child’s body systems, weight/height measurements, daily nutritional intake, daily activity, and previous attempts to manage weight (Nicholas & Livingston, 2002). Following the evaluation of data, a body mass index (BMI) should be calculated. The BMI is based on the child’s height/weight and is considered the most accurate measurement (Hodges, 2003). Based on a standardized growth chart a child with a BMI greater than 30 is considered obese (Nicholas & Livingston, 2002). Once the nurse has identified the child as being obese or at risk for becoming obese, he/she must evaluate parental perception.
It is critical for the RN to carefully evaluate the parental perception of their child’s health and their willingness to take part in a change. The primary concern with poor dietary practices lies between the parent and child. In one study, 79% of mothers failed to recognize their child as being overweight (Hodges, 2003). To be successful in combating this growing epidemic, it is vital for parents to recognize and accept their child’s need for interventions. Well child check-ups present an optimal opportunity for nurses to address these concerns. Key points the RN should assess with families include: exposure and accessibility of food to the child, modeling appropriate eating behaviors, providing food that leads to positive or negative physiological consequences, and feeding practices utilized (Hodges, 2003). After properly assessing an obese child and evaluating parental perceptions, family education on improving nutrition and physical activity can begin.
Children must receive proper nutrition and adequate physical activity to promote a healthy lifestyle. An individual’s body changes significantly during the ages of two and twenty. Each person’s required nutritional intake is based on their height, built, gender, and activity level. The appetite of children goes through peaks and troughs that correspond with their rate of growth. It is important for parents to understand that children may eat well one day and show minimal interest in food the next. Toddlers have high energy expenditure and small stomachs. They may need several small meals throughout the day. As children grow into teenagers they often develop erratic eating habits. This frequently includes skipping meals and snacking throughout the day (Readers Digest, 2007). It should not be of concern so long as nutritional snacks are provided. Physical expenditure for children has decreased over the years and sedentary activities such as television viewing, and hand-held video games have increased (Domrose, 2007). These behaviors have greatly contributed in the rise of obese children. To promote proper nutrition, physical activity, and assist the family in establishing healthy eating habits, the nurse must educate the parents. Education should consist of eating a balanced diet that includes appropriate portions of grains, fruits, vegetables, dairy, and meat, creative methods to encourage children to eat, and an environment that nurtures physical activity (Hodges, 2003). Following education, families can then take action and improve their quality of life.
A multidimensional approach is the best method in combating childhood obesity. Proper identification, parental assessment, and family education all need to be considered prior to interventions. The focus of care should be living a healthier lifestyle rather than reaching a target weight. Children will be more successful and compliant if they are not held to a restrictive regimen. It is the nurses’ responsibility to provide creative and encouraging methods to assist all children in becoming successful.

New Paper
A. Parental Contribution
Denial
In a study, 79% of mothers failed to recognize their child as being overweight. Many parents associate a heavy child as a healthy child. Parents will often base their competency as a father or mother on their child’s growth percentile. They fear a change in eating habits and daily lifestyle will deprive their child from the things they have come accustomed to. Parent education needs to be available to alleviate some of these concerns. This should include possible health risks their child could encounter if the current behavior continues. The nurse needs to teach the parents that there is a fine balance between introducing new habits as well as modifying old practices. Parental recognition and acceptance that their child is overweight is a vital component if the interventions are to be initiated and successful (Hodges, 2003).
Poor Role Modeling
Parents of obese children are often obese themselves. It would be counterproductive to implement healthy lifestyle interventions for a child if the parents are not willing to become an active participant. Children learn and mimic the behaviors that are exhibited in their environment. It is imperative that parent’s understand their influence with food selection and the level of physical activity that their children take part in. To implement a positive change and obtain optimal success in this ever growing epidemic the family unit as a whole needs to commit to a new way of living (Lindsay, Sussner, Kim, & Gortmaker, 2006).

B. Implementation of proper nutrition and physical activity
1. Nutrition
Nutrition is an important component when establishing a healthier lifestyle for overweight or obese children. This can create an obstacle for many families. With today’s fast paced society parents often resort to quick and convenient meals. These meals are often high and low in nutritional value. Parents need to be educated on how to make and plan nutritious meals that can fit into their day to day life. This can include meals at home, school, and/or dining out. Resources and information need to be provided to families prior to beginning a lifestyle change to ensure their success (Hodges, 2003).
2. Physical Activity
It is imperative that children participate in regular physical activity. Sports programs are an excellent way for children to receive adequate exercise while building relationships and forming valuable team work skills. For many families financial restraints prevent them from taking part in organized activities. These individuals have to seek other options when sports programs are unavailable to them. Research has shown that the more time children spend outdoors the more active they will become. This seems like a reasonable assumption and resolution for the families who can not afford to take part in organized activities. Many low-income families question the safety of this solution. They are concerned with traffic, drug dealers, crime, and violence that might be present in their neighborhoods. When working with families of obese children information and resources needs to be presented that overcomes this obstacle. Children will have a difficult time becoming healthy if they can not find a safe and accessible location to be active (Sallis & Glantz, 2006).

References

Berry, D., Galasson, P., Melkus, G., & Grey, M. (2004). Obesity in youth: Implications for the advanced practice nurse in primary care. Journal of the American Academy of Nurse Practitioners, 16, (8) 326. Retrieved Feb. 2, 2007 from ProQuest database.

Domrose, C. (2007, March 26). Small steps: Nurses take on childhood obesity. Nurseweek, mountain west edition, 10.

Hodges, E. A. (2003). A primer on early childhood obesity and parental influences. Pediatric Nursing, 29, (1) 13. Retrieved Jan. 19, 2007 from Expanded Academic ASAP database.

Lindsay, A.C., Sussner, K.M., Kim, J., & Gortmaker, S. (2006). The role of parents in preventing childhood obesity. Childhood Obesity: The Future of Children, 16 (1) 169-186. Retrieved Oct. 25, 2007 from http://www.futureofchildren.org/information2826/information_show.htm?doc_id=355732.

Nicholas, M. R. & Livingston, D. (2002). Preventing pediatric obesity: Assessment and management in the primary care setting. Journal of the American Academy of Nurse Practitioners, 14, (2) 55. Retrieved Feb. 2, 2007 from ProQuest database.

Readers Digest. (2006, March). Childhood nutrition: Food for the growing years. Retrieved Feb. 2, 2007, from http://www.rd.com/content/openContent.do?contentId=26202

Sallis, J.F. & Glanz, K. (2006). The role of built environments in physical activity, eating, and obesity in childhood. Childhood Obesity: The Future of Children, 16 (1) 89-108. Retrieved Oct. 25, 2007 from http://www.futureofchildren.org/information2826/information_show.htm?doc_id=355433.