Impacting Childhood Obesity

Obesity has become the largest health problem in the world surpassing AIDS and malnutrition. The World Health Organization (WHO) designated obesity as a global epidemic affecting adults and children (WHO, 2007).

The incidence of obese children continues to rise in all ages and ethnic groups, equally affecting both sexes, leading to an increased urgency for health care providers to identify and treat children who are obese or are at risk of becoming obese. In order to combat this problem nurses need to identify these children and use a holistic approach in treating and preventing childhood obesity by promoting family involvement in nutrition, positive lifestyle changes and client education regarding physical education.
Currently obesity is defined as having a body mass index (BMI) greater than 30 and a BMI over 25 is considered overweight: BMI equals kg/[height (m)]² (CDC, 2007). “In the United States, the most recent estimates of obesity prevalence are based on data from the 1999-2000 National Health and Nutrition Examination Survey 20.6% of 2- to 5-year-old children in the United States were overweight. In older children, this prevalence was even higher, with 30.3% of 6- to 11-year-old children and 30.4% of adolescents (12-19 years of age) being overweight” (Velasquez-Mieyer, Perez-Faustinelli, Cowan, 2005). Being overweight in childhood also leads to an increased risk of becoming an obese adult. Children and adolescents who have a BMI greater than the 95th percentile have a 62-98% chance of becoming obese adults (Guo SS, Wu W, Chumlea WC, Roche AF, 2002). Childhood and adult obesity lead to increased incidences of type-2 diabetes and cardiovascular disease (Drohan, 2002). Furthermore, over 50% of overweight children suffer from hypertension (Velasquez-Mieyer et. al., 2005). Genetics and parental influence also have a strong influence in determining a child’s predisposition to obesity: As stated by Velasquez-Mieyer , 2005 “biological relatives exhibit similarities in maintenance of body weight, and that heredity contributes between five and 40 percent of the risk for obesity”.
Early detection of overweight and obese children is essential in order for nurses to make a positive impact on the obesity epidemic. Routine assessments include obtaining the child’s height and weight is all that is needed to calculate BMI (kg/m²) and determine if the child is overweight. Identification can be performed during routine clinical visits, at health fairs, or during school health screening. Assessing the child’s parents is also very helpful in identifying a child who is at risk of becoming obese. “If one parent is obese the child is 4-5 times more likely to become obese” (Guo, 2002). This number increased to 13 times in children under 5 years of age if both parents are obese (Velasquez-Mieyer et al., 2005). Nurses need to recognize the importance of identifying overweight children and plan interventions as early as possible. “Interventions should be started when the child reaches the 75th percentile, not the 95th for their age. At this point the child has an adult equivalent BMI of 30” (obese), thus compounding complications and requiring a greater level of intervention. (Hoolihan L, 2005). Interventions should include education regarding health risks and nutrition, as well as promoting physical activity.
Once a child is identified as being overweight and at risk of becoming obese, education regarding obesity is of utmost importance. A nurse should take every opportunity possible to educate children and their parents. This could be during clinical visits, at school, or during health fairs. Education should include nutrition, physical activity, and the multiple health risks associated with obesity including diabetes, cardiovascular disease, and hypertension. Educating the child and particularly the parents can make a substantial impact on a child’s nutritional intake and lifelong habits. Parental influence is a strong determinant in a child’s behavior and nutritional habits. If parents consume high fat, high sugar diet without meeting daily requirements for fruit and vegetable intake, their children will likely follow this example (Hoolihan, 2005). Nutritional education should focus on foods that contain necessary nutrient requirements. A wide range of foods should be listed for sources of each nutrient as well as appropriate serving size. A nurse may also provide the family with a copy of the United States Food and Drug Administration’s food pyramid which lists serving recommendations of each food group and portion sizes. Informing parents of a healthy weight is an important step of education. Many people do not perceive their children as being overweight due to being “accustomed to seeing overweight youth”. “In fact, in certain ethnic and racial groups, overweight is increasingly accepted, almost expected.” (Hoolihan, 2005). Along with nutrition children must also maintain an active lifestyle to treat and prevent obesity.
Physical activity is an important step in preventing obesity. The amount of physical activity varies greatly among children and adolescents; however there is a direct correlation between the amount of regular physical activity and a child’s weight (United States Department of Health and Human Services, 2005). Watching television, video games and computer usage are activities that require an insignificant amount of physical activity. Estimates suggest that the average child in the United States spends 25% of their waking hours watching television (USDHHS, 2005), and “even more hours are spent watching television if the set is in the child's room” (Holcomb, 2004). Often children are consuming high calorie snacks while engaging in sedentary behaviors, further increasing the correlation between lack of physical activity and obesity. A recent examination of the Department of Education’s Early Childhood Longitudinal Survey (ECLS-K) found that a one-hour increase in physical education per week resulted in a 0.31 point drop (approximately 1.8%) in body mass index among overweight and at-risk first grade girls. There was a smaller decrease for boys (USDHHS, 2005). Nurses should stress the importance of physical activity and recommend various activities while educating patients regarding obesity. Examples of activities to recommend include a daily walk with the family, a YMCA membership, enrolling in school or county sponsored organized sports, or at last resort an interactive video game that requires dancing or other intense physical movement. A brief explanation of the benefits of being physically fit will also enhance a patient’s willingness to engage in physical activities. This should include physical changes such as weight loss, improved muscle tone and endurance, body image and self esteem, as well as how it benefits the metabolic and cardiac systems. Again promoting physical activity with the child’s family would help strengthen the family’s commitment to treat and prevent obesity.
Early identification, nutritional education and promoting physical activity are essential components of treating and preventing childhood obesity. Nurses often spend more time with clients than other heath care providers during clinical visits and health promotion activities, or illness prevention functions. Therefore, nurses have multiple opportunities to initiate and facilitate identification, education and physical activity that will have a positive impact on childhood obesity.
References:
Drohan, S.H. (2002) Managing early childhood obesity in the primary care setting: A behavior modification approach. Pediatric Nursing, 28, 599-611. Retrieved October 27, 2006, from ProQuest database. (277433901).
Guo SS, Wu W, Chumlea WC, Roche AF (2002) Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. American Journal of Clinical Nutrition. 76:653-658.
Holcomb S.S., (2004). Obesity in children and adolescents: Guidelines for prevention and management. Nurse Practitioner. 29(8), 9-13. Retrieved October 26, 2006, from ProQuest database (683132191).
Hoolihan, L. (2005) The role of education and tailored intervention in preventing and treating overweight. Nutrition Today 40.5: 224(10). Retrieved Feb 16, 2007, from Expanded Academic ASAP. A138397561
World Health Organization (WHO). (2006). Overweight and obesity. Fact sheet N-311. Retrived January 9, 2007, from: http://www.who.int/mediacentre/factsheets/fs311/en/index.html
United States Department of Health & Human Services. (2005). Childhood Obesity. Washington, DC. Retrieved January 9, 2007, from: http://aspe.hhs.gov/health/reports/child_obesity/
Velasquez-Mieyer, P., Perez-Faustinelli, S., & Cowan, P. A. (2005). Identifying children at risk for obesity, type 2 diabetes, and Cardiovascular Disease. Diabetes spectrum. 18(4), 213-221. Retrieved January 20, 2007 from ProQuest database (933878111).


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Impacting Childhood Obesity.
Early detection and identifying overweight and obese children.
Insufficient Parental knowledge regarding obesity and Body Mass Index.
Basic assessment of height and weight and calculating a BMI are part of every complete physical assessment. While this information provides valuable data for health care providers, parents are often unaware of what BMI indicates. A lack of information and teaching leads parents to disregard the significance and negative health consequences of a BMI above 25. Health care providers may not emphasize the importance of an elevated BMI assuming the parents are aware that their child is overweight and they understand the importance of such information. Culture may also effect the how a parent views their child’s weight and BMI, obesity is not stigmatized in some cultures as it is in others (Davis). This leads to increased boundaries regarding patient education and receptiveness to teaching.
Legal considerations preventing widespread Health screening and reporting for Children.
A majority of public grade schools institute annual health screening programs. From state to state a these programs are required to assess immunization compliance (50 states), vision (36 states), hearing (35 states), scoliosis (27 states), and dental (9 states). However few schools obtain BMI information, according to Center for Disease Control report (2006) only 11 states have policies that require height and weight to be obtained during health screening. Furthermore only 60% of schools sent information home regarding each component of the health screening, but less than 30% offered any health education to families (CDC, 2006). Broad Federal Government legislation covering school health screening is currently lacking. States are allowed choose what screening is performed and what information and teaching is offered to families. State to state legislation mandating minimum health screening also fails identify overweight children. To compound the problem only 3 states require schools to have at least 1 full time nurse (CDC, 2006). This leads to a lack of professional health assessment capability as well as planning and recording information from health screening activities.
2. Boundaries to successful interventions through education.
1. Socioeconomic status may prevent may prevent families from obtaining appropriate nutrition required to treat and prevent obesity.
Education aimed at providing nutritional information for overweight and obese children often emphasizes low fat foods, fresh fruit and vegetables, low fat dairy products and an avoidance of highly processed foods. Many processed and prepared foods are inexpensive, high in fat content, calories, and poor in nutrients. With an overwhelming availability of poor cheap food choices it is difficult for families to follow a nutritional diet. Fresh foods require preparation time and cost significantly more than pre-packaged and processed foods. Ounce for ounce potato chips cost less than apples, as does prepared fried chicken (loaded with saturated fats and oil) vs. fresh skinless chicken breast (98% fat free). The cost alone will prevent many families from obtaining nutritious foods. Convenience also plays a major role in nutritional decisions. Over 61 of all two parent families with children under 18 have two incomes, this leads to increased time away from home and less time for obtaining and preparing nutritional foods. Forty two percent of food dollars are spent on food consumed outside of the home.(Savage).
2. Poor feasibility in changing parental eating habits.
Obese children have learned to eat what their parents provide and aquire tastes and preferences similar to their parents beginning at birth. Educating a parent regarding proper food choices and encouraging them to follow the recommendations will not have a beneficial effect on the child’s weight if the parents do not concurrently change how and what they eat. Combating childhood obesity is compounded three fold by educating and promoting change in the child, the parent, and the entire family. To further complicate this 31% of children are cared for during mealtime by a caretaker or grandparent and 41% are enrolled in an organized day care center (Savage). This limits the parents influence on nutrition and relies on someone else to follow proper nutrition guidelines.