Childhood Obesity: Nursing Strategies for Prevention and Treatment of Childhood Obesity

The epidemic of childhood obesity carries with it numerous consequences and for the most part is completely preventable, as well as, treatable. Childhood obesity can lead to chronic health problems like cardiovascular disease, type 2 diabetes mellitus, and psychological problems like depression and low self-esteem. Even though obesity can be caused by some genetic conditions, it is mostly caused by poor diet and lack of exercise. Since childhood obesity carries with it detrimental health and mental consequences, nurses must focus strategies on educating families and communities about Body Mass Index monitoring, as well as, the importance of proper diet and exercise to prevent and treat childhood obesity.
Two of the major factors that cause childhood obesity are poor diet and a lack of physical activity or exercise. Singhal, Schwenk, and Kumar (2007) reported that almost all obesity in children is caused by poor food choices that lead to a greater caloric intake than needed. A reduction in physical activity and the increase in sedentary leisure options like video games and watching television contribute to childhood obesity (Australian Centre for Evidence Based Nutrition and Dietetics 2007). Body Mass Index (BMI) is a measurement that is used to tell whether or not a child is at risk for becoming overweight, is overweight, or even underweight (Johnson & Ziolkowski, 2006). BMI is often used because the data is easily obtainable. According to the Centers for Disease Control and Prevention (CDC) a child is considered obese if they fall above the 95th percentile and at risk of becoming obese if they fall between the 85th and 95th percentile on their age and gender specific BMI growth charts. Obesity can lead to hypercholesterolemia, hypertension, dyslipidemia, hyperinsulinism, type 2 diabetes mellitus, menstrual irregularity, low self esteem, and depression (Krebs, Jacobson, Greer, Heyman, Jaksic, Lifshitz, et al 2003). Nursing strategies aimed at the prevention and treatment of childhood obesity could greatly impact this epidemic.
One nursing strategy would be to implement BMI screening and parental notification programs in schools. Most school districts require school nurses to obtain weight and height measurements on their students on a regular basis, and these are the two measurements needed to find BMI (Johnson & Ziolkowski, 2006). By doing a simple calculation school nurses can find where their students fall on the CDC’s BMI screening charts. Some parents may not know the impacts of childhood obesity or even that their children are at risk, but if this information is offered it provides them with the opportunity to follow up with a health care provider or seek more information. In the East Penn School District a BMI screening program like this was implemented by the school district and as a result the children in that school district have been below the national average for childhood obesity for the past 5 years (Johnson & Ziolkowski, 2006).
Along with BMI screening nurses can focus strategies on educating and promoting exercise and physical activity to families and communities. When more calories are taken in than are spent through physical and metabolic activity, weight gain occurs. As a result, sedentary lifestyles and a lack of physical activity have been directly linked to childhood obesity. According to Ruxton (2004) 40% of boys and 60% of girls fail to meet the Health Development Agency’s recommendations of 30 to 60 minutes of physical activity a day. By encouraging families to participate in fun, interactive, structured exercise like sport’s teams, karate, or dance, nurses can help reduce these numbers. According to Krebs et al. (2003), children that watch 4 or more hours of television a day have significantly greater BMIs than children that watched 2 or fewer hours daily. By providing anticipatory guidance about physical activity, nurses can help families recognize that they make an impact of their children’s development of lifelong habits, like exercise that will help prevent and treat childhood obesity.
Educating families and communities about the importance of proper nutrition is another strategy that nurses can employ to combat childhood obesity. Since obesity is linked to poor food choices or excess food intake, nurses can educate families on making small specific changes that can make a huge difference. Some of these changes include: replacing whole milk with reduced fat or skimmed milk, replacing sugary drinks like soda and juices with 100% juice drinks and water, replacing calorie dense snacks like chips and candy with fruits and vegetables, and eating lean meats like chicken and turkey. Foods high in fiber and whole grains should be encouraged in a proper diet, too. When it comes to educating parents about proper nutrition, nurses should remind them of the importance of encouraging a child’s autonomy in self regulation of food intake while setting appropriate limits on choices (Krebs, et al. 2003). Allowing children the time they need to eat and being proper role models are good nutritional practices that nurses should promote in schools, child-care settings, and at home. Providing education about proper diet and nutritional habits is a pertinent nursing strategy that aids in the prevention and treatment of childhood obesity.
Treating and preventing childhood obesity are crucial in helping children to avoid having to suffer from life-threatening diseases and life altering mental health. The epidemic of childhood obesity is on the rise, and nurses have the ability to make a huge impact on it. Employing key nursing strategies that are focused on education about proper diet and exercise, and BMI screening with parental notification are critical in fighting this epidemic. Children who eat a proper diet and get an adequate amount of physical activity have significantly less BMIs than children who do not. Nurses must employ these key strategies aimed at prevention, as well as, treatment in order to make great strides in fighting the epidemic of childhood obesity.
Intervention #1
Nurses can focus on implementing BMI screening programs in schools with parental notification using the CDC’s BMI screening charts.
Disadvantage #1
Even though BMI screening is great in assessing a child’s weight status it still has limitations. BMI is the ratio of weight in kilograms to the square of height in meters. If these measurements and calculations are not done accurately then the percentile on the CDC’s growth charts in which a child falls will be inaccurate, and the measurement will be useless. According to Johnson & Ziolkowski (2006) BMI does not differentiate between central adiposity and peripheral adiposity and it does not differentiate between lean muscle mass and fat tissue mass. When implementing BMI screening programs nurses must keep these limitations in mind.
Disadvantage #2
The subject of childhood obesity is sensitive and sometimes viewed as private, therefore, parents may not view the school nurse’s involvement as positive. In the East Penn School District where a BMI screening program with parental notification was implemented, over half of the parents that receive letters notifying them of what percentile their child was in, viewed the school’s involvement as meddling, (Johnson & Ziolkowski, 2006). When health care professionals discuss the issue of a child’s weight with their parents, the parent’s may feel as if they are being blamed or they are being pressured, (Singhal et al. 2007). When a nurse addresses the issue of a child’s weight with the child’s parents they must show sensitivity and compassion so that further education and intervention can be implemented.
Intervention #2
Nurses need to educate families and communities about the importance of proper diet to prevent and help treat childhood obesity.
Disadvantage #1
Even if nurses provide families and communities with proper education about diet to prevent and treat childhood obesity, a low socioeconomic status could prevent families from implementing a proper diet. “Children from low-income households are more likely to become overweight than are children from higher-income households. Food insecurity and not having access to healthy food choices are reasons for this situation,” (Larsen, Mandelco, Williams, & Tiedman, 2006). Nurses can make every effort to empower families with education about proper diet, but having a low socioeconomic status may prevent them from being able to make proper food choices.
Disadvantage #2
Education about diet alone is not enough to prevent and treat childhood obesity. Since weight is directly linked to caloric intake and energy expenditure, education about diet to prevent and treat childhood obesity should also include education about activity levels and exercise. According to Singhal et al. (2007), the epidemic of childhood obesity is likely the result of a gradually increasing caloric intake and a decreasing level of physical activity. According to Krebs et al. (2003) the best approach in the treatment and prevention of childhood obesity is to incorporate assessment and anticipatory guidance about diet, weight, and physical activity. When nurses are educating families about proper diet to treat and prevent childhood obesity they should also offer education about physical activity and exercise.
References
Australian Centre for Evidence Based Nutrition and Dietetics (2007). Effective dietary interventions for overweight and obese children. Australian Nursing Journal 14(11), 31- 34. Retrieved January 16, 2008, from Academic Search Premier database (A25325766).
Johnson, A., & Ziolkowski, G. A. (2006). School-based body mass index screening program. Nutrition Today 41(6), 274-276. Retrieved April 28, 2007, from Expanded Academics ASAP database (A157267504).
Krebs, N. F., Jacobson, M. S., Greer, F. R., Heyman, M. B., Jaksic, T., Lifshitz, F., et al (2003). Prevention of pediatric overweight and obesity. Pediatrics, 112(2). Retrieved October 6, 2007, from http://aapolicy.aapublications.org/cgi/content/full/pediatrics;112/2/424#RFN1.
Larsen, L., Mandelco, B., Williams, M., Tiedman, M., (2006). Childhood Obesity: Prevention
practices of nurse practitioners. The American Academy of Nurse Practitioners 18(2) 70-79. Retrieved May 5, 2008, from Academic Search Premier database (AN1957198).
Ruxton, C., (2004). Obesity in children. Nursing Standard 18(20), 47-52. Retrieved January 16, 2008, from Academic Search Premier database (13054939).
Singhal, V., Schwenk, W. F., & Kumar, S. (2007). Evaluation and management of childhood and adolescent obesity. Mayo Clinic Proceedings 82(10), 1258-1264. Retrieved January 16, 2008, from Academic Search Premier database (A27176893).