Prevention of Childhood Obesity: the Nurse’s Role

Childhood obesity is an increasing problem in America today with far-reaching consequences. The nutrition information and eating behaviors learned as children are carried into adulthood, shaping the health status of individuals. The early prevention and treatment of childhood obesity is necessary to reduce health complications and increase the quality and length of life. Because of the increasing prevalence of childhood obesity, nurses must proactively reduce the risk of childhood obesity through nutrition education, behavior modification training for parents and children, and community and school policy changes.
Childhood obesity has been an issue in America for many decades and, according to Sheehan (2004), over the last 20-25 years the number of affected children has tripled. The simple fact that almost 20% of children are currently classified as obese (measured by a BMI of over 30) should indicate the need to attack this epidemic from any and all angles (Henry & Royer, 2004). In addition to the increased number of health issues surrounding obesity, there is also the economical strain this epidemic has placed on the affected individuals and their communities. For example, Ruxton (2004) cited the estimate of treatment costs for obesity in the UK, in the early 2000s, as exceeding half a billion pounds (~$850 million) per year. Given the population difference between the UK and the U.S., it can be extrapolated that the cost to treat obesity in America is considerably higher and climbing each year as the number of obese individuals increases.
As with any prevention plan, knowledge is the logical starting point. Teaching parents and children about proper nutrition can be accomplished by nurses during scheduled well child visits as well as in schools by the school nurse on staff. Nutritional education should provide a sound, strong base from which to build a healthy lifestyle from infancy through adulthood. For example, it has been suggested that food choices during pregnancy influence the food likes and dislikes of the unborn child, so learning about good nutrition is never too early (Sheehan, 2004). Nurses can be involved in the different levels of education offered to parents and children as they grow and as their needs change. Horodynski and Stommel (2005) emphasize that the effectiveness of nutritional education is significantly increased when it is taught to the parents and caregivers of toddlers. They also suggest that the earlier good eating habits begin, the more likely those habits will prevent childhood obesity and last into adulthood. Nurses should take advantage of early doctor’s visits to emphasize the importance of sound nutrition. However, knowledge and education are not enough to affect this growing epidemic.
In addition to nutritional education, nurses must introduce behavior modification techniques to parents and children to help fight obesity. This can be achieved during doctor’s visits for children as well as parents because instilling good eating behaviors is more effective when the whole family follows the same practices. Various practices by parents, such as using food as rewards or bribes to get a child to behave a certain way, have proven to lower the child’s ability to recognize internal hunger and satiety cues for eating properly (Drohan, 2002). These improper uses of food teach children to attach different meanings and emotions to different foods instead of simply viewing them as energy fulfillment. One important behavior modification suggested by Drohan is the reduction of television viewing, especially during mealtimes. Additionally, Drohan (2002) asserts that the home implementation of four core principles of behavior modification—self-monitoring, social reinforcement, stimulus control, and parental modeling—will lay the foundation for positive behaviors that will endure for much longer than knowledge alone.
As well as direct interaction with children and parents, nurses can indirectly assist in the battle against childhood obesity by influencing important policy changes and program introductions in schools and communities. Because children spend an enormous amount of time in school, the environment of those schools should be addressed regarding the nutrition offered and the physical activities available. School nurses are uniquely positioned to observe the health of American youth and to offer strategies for prevention and change. A roundtable conference of school health professionals that convened in Washington, D. C., concluded that prevention is preferred to treatment and that guidance should be provided to students for better food choices and increased physical activity. It was also suggested that schools review their existing policies on physical activities and foods available to the students during school hours. For example, Arkansas removed vending machines in elementary schools in 2002 and Los Angeles banned soda sales in its entire school district in 2005 (School Nurses, 2006). These are just two examples of what can be accomplished in communities through policy changes. Henry and Royer (2004) state that, “Nurses must work together and act now to create a more healthy environment for the young people of our nation” (p. 163).
The increasing level of childhood obesity in America is both startling and frightening. Children are being raised in households and schools where fast food is a staple and fruits and vegetables have become unavailable. These learned eating patterns last into adulthood and are cause for great concern for the health and well-being of the U.S. population. Because of the increasing prevalence of childhood obesity, nurses must proactively reduce the risk of childhood obesity through nutrition education and behavior modification training for parents and children. The nursing strategies of nutrition education, behavior training, and fighting for various policy changes have proven to be effective in changing habits and increasing nutritional awareness. Used in conjunction with each other they will effectively fight the childhood obesity epidemic.
References
Drohan, S. (2002). Managing early childhood obesity in the primary care setting: A behavior modification approach. Pediatric Nursing, 28(6), 599-610. Retrieved April 17, 2007, from Proquest database.
Henry, L. & Royer, L. (2004). Community-based strategies for pediatric nurses to combat the escalating childhood obesity epidemic. Pediatric Nursing, 30(2), 162-164. Retrieved April 17, 2007, from Proquest database.
Horodynski, M. & Stommel, M. (2005). Nutrition education aimed at toddlers: An intervention study. Pediatric Nursing, 31(5), 364-370. Retrieved April 10, 2007, from Proquest database.
Ruxton, C. (2004). Obesity in Children. Nursing Standard, 18(20), 47-55. Retrieved April 17, 2007, from Expanded Academic database.
School nurses, school-based health centers and childhood overweight: A report from a roundtable meeting to explore the role of school health professionals in preventing childhood overweight (2006). Retrieved April 17, 2007 from http://www.healthinschools.org/sh/obesityreport.asp.
Sheehan, J. (2004). Fighting childhood obesity. Retrieved September 24, 2007 from http://www.parents.com/parents/printableStory.jsp?storyid=/templatedata/hk/
story/data/AB0904KidObesity_09172004.xml.

Intervention #1
Nurses need to provide children and their families with proper and adequate nutrition education.
Disadvantage #1
One problem nurses face in providing nutritional education to children and parents is simply being able to reach them in order to convey the information. Lack of health insurance coverage and/or access to health care facilities for patients can greatly hinder this effort. According to Slang and Bayerl 14% of children under the age of 18 lacked health insurance coverage in 1999 (2003). They also stated that poverty stricken children have a greater likelihood of not having a regular source of health care and therefore have reduced access to nutrition education, screening and counseling (Slang & Bayerl, 2003). These obstacles need to be identified so that nurses can find alternate routes for information transfer, including the numerous public food and nutrition programs in existence on local and federal levels.
Disadvantage #2

Another difficulty related to nutritional education is the ability for patients to apply new knowledge. The socioeconomic status of individuals determines how much money is budgeted for food purchase. Due to the low cost of many nutrient-deficient, energy-dense foods and the higher cost of fresh fruits and vegetables, the majority of persons in lower income families choose to purchase the cheaper, less nutritive foods. The study cited by Foster indicated that families were cutting down on the amount of healthy foods purchased because they could not afford them (2007). Simply having the education is not enough when implementation of that education is financially impractical.
Intervention #2
Nurses need to actively seed policy changes and program introductions in schools and communities to decrease childhood obesity.
Disadvantage #1
The media poses one of the biggest barriers to the nursing effort of combating childhood obesity. Television and other forms of food advertising represent the main culprit (Rollins, 2004). Companies are built and maintained based on revenue and advertising products ensures that people will be aware of their existence and look for them while shopping. This same concept applies to children who view the advertisements and consequently request those items while in the supermarket (Rollins, 2004). Decreasing the amount of time children are exposed to media advertisements and/or changing the content of the commercials to promote healthier food choices are policy options presented by public health experts to assist in the prevention of childhood obesity.
Disadvantage #2
Funding for policy changes and program introductions for schools and communities is essential, however, coming up with the money in any budget proves more difficult. These changes need to be permanently instituted in our schools and communities for longterm effectiveness. However, budgeting for these policy changes and programs proves very difficult. Any federal or state mandate targeted towards reducing childhood obesity by requiring nutrition and physical education in every school comes at the financial cost to the school districts (Hayne, Moran & Ford, 2004). Thus, creating obesity reduction programs is less of a dilemma then acquiring the financial means to support them.
References
Foster, M., (2007). Food Cost Influences Choices. The Skanner (Seattle Edition), 12(13), 1-3. Retrieved April 15, 2008 from Proquest database.
Hayne, C., Moran, P., & Ford, M., (2004). Regulating environments to reduce obesity. Journal or Public Health Policy, 25(3/4), 391-407. Retrieved April 15, 2008 from Proquest database.
Rollins, J., (2004). Kaiser Family Foundation releases report on role of media in childhood obesity. Pediatric Nursing 30(2), 165. Retrieved April 15, 2008 from Proquest database.
Stang, J. & Bayerl, C., (2003). Position of the American Dietetic Association: Child and adolescent food and nutrition programs. Journal of the American Dietetic Association, 103(7), 887-893. Retrieved April 15, 2008 from Proquest database.