Sunday, December 2, 2007

The Nurses Role in the Prevention of Childhood Obesity

Obesity is the number one childhood and adolescent nutritional disease in the United States. Currently about 11% of children and adolescents are classified as being overweight with an additional 14% at risk for becoming overweight (Story et al., 2002).

The prevalence of childhood obesity has tripled in the last twenty years. Obesity in children can cause many physical and psychological problems that can be long lasting. Because childhood obesity is a growing problem in the United States and can have lasting effects throughout the child’s life, the nurse must play a key role in preventing childhood obesity by assessing parental perceptions about obesity, educating parents about their influence over their child in regards to proper nutrition and eating habits and teaching parents behavior modification techniques.
There are many ways to measure obesity. Body mass index (BMI) is the best measure of obesity for children ages two through twenty (Hodges, 2003). BMI compares height and weight to help measure fat. A BMI of 25-29 equals overweight and a BMI 30 or greater equals obese (Healy, 2006). Many health problems are linked with obesity, some include hypertension, type 2 diabetes, orthopedic problems, asthma, cardiovascular disease, low self esteem and depression. There are three main risk factors for obesity: prenatal, genetic and environmental. The parents play a key element in controlling and changing the home environment (Regber, Berg-Kelly & Marild, 2007). The nurse has an obligation to help change the environmental risk factors.
An important step in the treatment and prevention of childhood obesity is recognizing the problem. Pediatric nurses have the opportunity to assess children at least twelve times before the age of five (Drohan, 2002). This is the time for nurses to question and assess the parental perceptions of obesity. Studies have shown that some mothers believe that a bigger child is a healthy child and that a child’s size is predestined and therefore it does not matter how much a child eats (Drohan, 2002). Studies have also shown that some parents did not think their obese children were overweight (Hodges, 2003). A WIC study found that some parents believed that the higher their child was on the growth curve, the healthier the child was and in turn meant they were more competent parents (Hodges, 2003). Nurses play a key role in educating parents about what obesity is and how it relates to the growth curve. This education should start when the child is born. Nurses can educate parents at well-child visits, health fairs and parenting classes. “Parental recognition and acceptance that their child is over-weight is vital if interventions are to be initiated and successful.” (Hodges, 2003, para. 12).
While parental recognition and acceptance is the first step in the prevention and treatment of childhood obesity, educating parents about their influences over their child is the second step. Parents play a key role in the development of proper eating habits in their children and should be educated about proper nutrition and serving sizes. A toddler’s portion size should only be 1/8-1/2 the size of an adults and children should eat small, frequent meals (Horodynski & Stommel, 2005). Eating habits and food preferences are learned early in life; therefore children should be exposed to various healthy foods at a young age. Parents should be taught not to use food as punishment or reward as this can lead to negative feelings about particular foods (Drohan, 2002 & Hodges, 2003). Nurses can teach parents to present healthy, nutritious food in a positive way. Studies have found that when food is presented to children in a positive way, the preference for the food increased (Drohan, 2002). Parents must be taught to let their child self-regulate their food intake. This will allow children to become aware of their internal hunger cues. Nurses should remind the parents that the child may not be hungry at the same time as the parents are. Parents should be taught not force the child to eat and this includes making the child clean his/her plate.
Nurses should teach parents of obese children behavior modification techniques because these have been found to make the biggest difference in an obese child’s weight (Drohan, 2002). These techniques include self monitoring, social reinforcement, stimulus control and role modeling. Self monitoring involves keeping a journal of the place, time and quantity of foods eaten as well as noting exercise and physical activity. The next technique requires the nurse to teach parents social reinforcement techniques. Praise should be given to children as soon as a good behavior is noticed and the parents should be very specific in stating what the praise is for. Stimulus control involves confining eating to one specific area of the house such as the kitchen or dining room and not allowing eating in front of the television or other places where overeating and inactivity occur. Modeling involves being a good role model for the child. Parents should not do things in front of their children that they do not want their child to imitate. Nurses should stress that parents and children both play an important role in making the behavior modification techniques successful.
In conclusion, nurses can help change the environmental factors that lead to childhood obesity. The number of obese children is increasing daily. Because childhood obesity is a growing problem in the United States and can have lasting effects throughout the child’s life, the nurse must play a key role in preventing childhood obesity by assessing parental perceptions about obesity, educating parents about their influence over their child in regards to proper nutrition and eating habits and teaching parents behavior modification techniques. With these three interventions, nurses should be able to help put a stop to the growing number of obese children in the United States.

Intervention 1: Assess parental perceptions of obesity
Disadvantage 1: Medical insurance
Well child visits are an important time for educating parents and assessing children. Low-income uninsured children are less likely than low-income insured children to have a usual source of medical care or receive any well child care (Davidoff, Dubay, Kenney, Yemane, 2003). Having an uninsured parent and an insured child is a risk factor also. These low income insured children are less likely to receive any medical visits and are less likely to receive well child care than children of insured parents (Davidoff et al., 2003). Nurses are not able to assess parental perceptions of obesity if parents are not bringing their child in for medical visits. Even when parents and children do go to medical appointments, health care professionals have stated that they do not have enough time to counsel and educate the parents. Although the majority of health care professionals stated they had dieticians who could counsel the families, a lot of insurance would not cover a dietician (Larsen, Mandleco, Williams, Tiedman, 2006).

Disadvantage 2: Culture, ethnicity, socioeconomic status
As Forster-Scott (2007) states, “Different ethnic groups have varying ideas about the meaning of overweight and obesity that may be different from those of mainstream American culture or of medical and science practitioners in the country” (para 13). In some cultures, a girl with a thicker body is a sign of good eating and good health. Nurses should also be aware that people of different cultures may eat a different diet than the typical American diet. Suggestions about diet changes made by the nurse may not include foods these families typically eat and so the nurses teaching may be ineffective. Socioeconomic status is a risk factor of a child becoming obese also. A study done on low income mothers showed that these mothers believed that a bigger child is a healthier child (Drohan, 2002). Another study done by Supplemental Nutrition Program for Women, Infants and Children (WIC) showed that some low-income mothers believed that the higher their child was on the growth curve, the healthier their child was (Hodges, 2003). Children from low income families are at a greater risk of becoming obese than children from higher income families. This is due in part to not having access to healthy food choices (Larsen et al., 2006). Food selection is often based on what is available in the grocery store and what the parents can afford. Healthy foods are usually more expensive and may not be as available in grocery stores in low-income neighborhoods (Forster-Scott, 2007).

Intervention 2: Educating parents of obese children behavior modification techniques.
Disadvantage 1: Lack of parental time.
“For young children, parental involvement in obesity treatment is inevitable and necessary” (Drohan, 2002, para 34). Studies have shown that families with two working parents were often too busy to prepare healthy meals and would turn to fast food instead (Larsen et al., 2006). Children from single-parent families are at even a greater risk than children from two working parent families. These children were found to eat more high fat foods and drink more soda and sweetened fruit drinks (Bowman, Harris, 2003). It is difficult for parents to teach behavior modification when they are not around to witness the type and amount of food their child is eating. Families are spending less time eating together and children are often fed by someone other than their parents (Savage, Fisher, Birch, 2007).
Disadvantage 2: Care provider education
Care providers may not feel they have the proper education to teach parents of obese children behavior modification techniques. Studies have shown that there are few opportunities to learn the most current assessments, counseling strategies and behavioral management techniques (Story et al., 2002). Story states “these topics are seldom covered in medical, nursing or dietetic school curricula, and postgraduate training opportunities are limited” (para 23). Caregivers need to develop greater skills in behavioral management strategies and parenting techniques, so they can support parents of obese children more effectively (Regber, Berg-Kelly, Marild, 2007).



References

Bowman, S.A. & Harris, E.W. (2003). Food security, dietary choices and television-viewing status of preschool aged children living in single-parent or two parent households. Family Economics and Nutrition Review, 15 (2), 29-. Retrieved October 28, 2007 from http://proquest.umi.com

Davidoff, A., Dubay, L., Kenney, G., Yemane, A. (2003). The effect of parents’ insurance coverage on access to care for low-income children. Inquiry – Excellus Health Plan, 40 (3), 254-. Retrieved October, 28, 2007 from http://proquest.umi.com

Drohan, S. H. (2002). Managing early childhood obesity in the primary care setting: A behavior modification approach. Pediatric Nursing, 20 (6). Retrieved January 21, 2007 from http://www.medscape.com/viewarticle/448019_2

Forster-Scott, L., (2007). Sociological factors affecting childhood obesity. Journal of Physical Education, Recreation & Dance, 78 (8), 29-. Retrieved October 28, 2007 from http://proquest.umi.com

Healy, B. (2006). Obesity gets an early start. US News and World Report, 141 (8), 79. Retrieved January 7, 2007 from Expanded Academic ASAP database (A150374028).

Hodges, E.A. (2003). A primer on early childhood obesity and parental influence. Pediatric Nursing, 29 (1), 13-16. Retrieved October 28, 2006 from http://www.medscape.com/viewarticle/448019_3

Horodynski, M.A., & Stommel, M. (2005). Nutrition education aimed at toddlers: An intervention study. Pediatric Nursing, 31 (5), 364-. Retrieved October 20, 2006 from Expanded Academic ASAP database (A137860102).

Larsen, L., Mandleco, B., Williams, M. & Tiedeman, M. (2006). Childhood obesity: Prevention practices of nurse practitioners. Journal of American Academy of Nurse Practitioners, 18. Retrieved October 27, 2007 from Academic Search Premier

Regber, S., Berg-Kelly, K., & Marild, S. (2007). Parenting styles and treatment of adolescents with obesity. Pediatric Nursing, 33 (1), 21-. Retrieved April 18, 2007 from Expanded Academic ASAP database (A160925920).

Savage, J.S., Fisher, J.O., & Birch, L.L. (2007). Parental influence on eating behavior: Conception to Adolescence. The Journal of Law, Medicine & Ethics, 35 (1), 22-. Retrieved October 27, 2007 from http://proquest.umi.com.

Story, M.T., Neumark-Stzainer, D.R., Sherwood, N.E., Holt, K., Sofka, D., Trowbridge, F.L., et al. (2002). Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals. Pediatrics, 110 (1), 210-. Retrieved January 7, 2007 from Expanded Academic ASAP database (A89576246).

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