Childhood Obesity Prevention: A Call to Action for the APRN Sarah M Kinnard RN, BSN-BC Augustina Manuzak MD, MPH, PhD

Objectives Explore the magnitude of the childhood obesity epidemicExplore the magnitude of the childhood obesity epidemic Present a childhood obesity epidemiological modelPresent a childhood obesity epidemiological model Explain the role of the APRN in fighting childhood obesityExplain the role of the APRN in fighting childhood obesity Discuss primary, secondary, and tertiary preventionDiscuss primary, secondary, and tertiary prevention Recognize national, state, and local resourcesRecognize national, state, and local resources Identify recommendations for clinical practiceIdentify recommendations for clinical practice Provide suggestions for further epidemiological studyProvide suggestions for further epidemiological study

Clinical Definition Childhood obesity – a BMI greater than or equal to the 95 th percentile for a child of the same age and sex Childhood obesity – a BMI greater than or equal to the 95 th percentile for a child of the same age and sex CDC. (2011). Healthly weight-it’s not a diet, it’s a lifestyle. Retrieved from mi.html

Childhood Obesity: A Serious Health Issue Psychosocial problems Psychosocial problems Health Consequences Health Consequences Likelihood that obesity in a 4 year-old child continues into adulthood is 20%, increases to 80% by adolescence Likelihood that obesity in a 4 year-old child continues into adulthood is 20%, increases to 80% by adolescence Overweight adolescent children experience increased mortality after the age of 30 years Overweight adolescent children experience increased mortality after the age of 30 years Psychosocial problems Psychosocial problems Health Consequences Health Consequences Likelihood that obesity in a 4 year-old child continues into adulthood is 20%, increases to 80% by adolescence Likelihood that obesity in a 4 year-old child continues into adulthood is 20%, increases to 80% by adolescence Overweight adolescent children experience increased mortality after the age of 30 years Overweight adolescent children experience increased mortality after the age of 30 years

Prevalence More than 16 million children in the U.S. currently suffer from obesity Obesity more than doubled in U.S. children and quadrupled in U.S. adolescents in the past 30 years Obesity in children (aged 6-11) increased from 7% in 1980 to nearly 18% in 2012 Obesity in adolescents (aged 12-19) increased from 5% to nearly 21% in 2012

STATE VS. COUNTY Low-Income Children Disproportionately Affected 2009 State Obesity Prevalence Among Low-Income Children Aged 2 to 4 Years County Obesity Prevalence Among Low-Income Children Aged 2 to 4 Years Source: Centers for Disease Control and Prevention. (2011c). Obesity and extreme obesity rates decline among low-income preschool children. Retrieved from

Epidemiological Model for Childhood Obesity Host genetics age nutrition knowledge deficit Causative Agent energy dense foods frequent snacks large portion sizes sedentary lifestyle Environment limited availability of fruits & veggies fast-food marketing inaccessibility to safe parks & bike paths

Role of the APRN Physical exam, weight, height, & BMI should be obtained at every wellness visit Screen pediatric patients following specific diagnostic recommendations Determine the presence and level of risk for obesity-related health complications Provides patient and parents with nutritional education and resources

Levels of Prevention Primary prevention – focused on maintaining a healthy weight status and can be accomplished by preschool education curriculum to promote healthy eating, physical exercise, and reducing screen timePrimary prevention – focused on maintaining a healthy weight status and can be accomplished by preschool education curriculum to promote healthy eating, physical exercise, and reducing screen time Secondary prevention – focused on obtaining a healthy weight status for overweight and obese children by promoting a healthy diet, increasing physical activity, and encouraging family supportSecondary prevention – focused on obtaining a healthy weight status for overweight and obese children by promoting a healthy diet, increasing physical activity, and encouraging family support Tertiary Prevention – focused on reducing obesity- related complications and premature death, which include meal replacement, pharmacological therapy, and weight loss surgeryTertiary Prevention – focused on reducing obesity- related complications and premature death, which include meal replacement, pharmacological therapy, and weight loss surgery

National Resources ProgramOrganizationDescription The Healthy Meals Resource System Food and Nutrition Information Center, National Agricultural Library, U.S. Department of Agriculture This online resource system is designed to assist state and local school food service and childcare programs in meeting the Dietary Guidelines for Americans. Web site: Let’s Move!White House, Health and Human Services, U.S. Department of Agriculture & Department of Education This Web site provides ideas on how to improve physical activity and nutrition in schools and at home. It has a section for children with activities and games. Web site: We Can! Ways to Enhance Children’s Activity & Nutrition National Heart Lung and Blood Institute, National Institutes of Health The goal of this program is to support families and communities in helping children maintain a healthy weight. Web site: /obesity/wecan/ /obesity/wecan/

State & Local Resources ProgramOrganizationDescription Fresh Fruit and Vegetable ProgramHawaii State Department of Education, National School Lunch Program This program target the nutritional needs growing and developing elementary school students, offering fresh fruit and vegetable snacks throughout the school day. Web site: Hawaii Let’s Go! Hawaii Initiative for Childhood Obesity Research and Education This program promotes healthy lifestyles for children and families. The slogan represents a set of behaviors associated with healthy weight in children; 5 or more fruits and vegetables, no more than 2 hours of screen time, 1 hour or more of moderate activity, and almost no sugar- sweetened beverages daily. Web site: Hawaii Nutrition and Physical Activity Coalition Hawaii State Department of Health This website offers non-bias data and information about community health on the Hawaiian islands. Web site:

Recommendations for Clinical Practice Obtain height, weight, and plot BMI on growth chart during every wellness exam Assess daily consumption of fruits and vegetables and engagement of at least 60 minutes of moderately active playtime daily. Identify vulnerable populations or those at greatest risk for childhood obesity allowing anticipatory guidance and intervention before obesity develops. Provide nutritional information and discuss appropriate exercise for the developmental age of the child. Discuss any concerns parents may have about their child’s weight with a non-judgmental and blame-free attitude Provide parents with national and local resources to encourage and support long-term changes in behaviors.

Recommendations for diagnosing and managing childhood obesity Source: Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38 (9), doi: /01.NPR e2

Recommended review of systems to detect obesity-related complications Source: Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38 (9), doi: /01.NPR e2

Suggestions for Further Epidemiological Study Obesity in the youth of minority groupsObesity in the youth of minority groups Obesity in children from a low-socioeconomic statusObesity in children from a low-socioeconomic status Focus on developing effective family-based prevention interventions for minoritiesFocus on developing effective family-based prevention interventions for minorities Development of a standardized measurement for obesity in ethnic groupsDevelopment of a standardized measurement for obesity in ethnic groups

Conclusion Childhood obesity in children and adolescents has reached epidemic proportions Serious health consequences of childhood obesity may lead to comorbid conditions, threating life and increase mortality National and State resources are available for childhood obesity Considering the APRN may be the sole provider for childhood obesity prevention and treatment in medically underserved areas necessitates knowledge of obesity screening, clinical diagnosis, prevention, treatment guidelines, and management Suggestions for further epidemiological study include emphasis on minorities and those from low-socioeconomic status, focus on effective family-based prevention interventions for minorities, and the development of a standardized measurement for ethnic groups

References American Academy of Pediatrics Committee on Nutrition, Policy Statement. (2003).Prevention of pediatric overweight and obesity. Pediatrics, 112, Retrieved from Behan, D. F., & Cox, S. H. (2010). Obesity and its relation to mortality and morbidity costs. Retrieved from Berkowitz, B., & Borchard, M. (2009). Advocating for the prevention of childhood obesity: A call to action for nursing. The Online Journal of Issues in Nursing, 14 (1). doi: /OJIN.Vol14No1Man02 Centers for Disease Control and Prevention. (2011). Healthy weight-it’s not a diet, it’s a lifestyle. Retrieved from Centers for Disease Control and Prevention. (2012). Prevalence of obesity among children and adolescents: United States, trends through Retrieved from Centers for Disease Control and Prevention. (2013). Public health genomics: Genomics and health. Retrieved from Centers for Disease Control and Prevention. (2014). Adolescent and school health: Childhood obesity facts. Retrieved from Choudhary, A. K., Donnelly, L. F., Racadio, J. M., & Strife, J. L. (2007). Disease associated with childhood obesity. American Journal of Roentgenology, 188(4), Retrieved from

References Gonzalez-Suarez, C., Worley, A., Grimmer-Somers, K., & Dones, V. (2009). School-based interventions on childhoodoObesity: A meta-analysis. American Journal of Preventive Medicine, 37 (5), doi: /j.amepre Hawaii Department of Health. (2012). State of Hawaii primary care needs assessment data book Retrieved from Hoelscher, D. M., Kierk, S., Ritchie, L. & Cunningham-Sabo, L. (2013). Position of the Academy of Nutrition and Dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity. Academy of Nutrition and Dietetics, 113(10), Retrieved from Karnik, S., & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal Of Preventive Medicine, 3 (1), 1-7. Retrieved from Novotny, R., Oshiro, C., & Wilkens, L. (2013). Prevalence of childhood obesity among young multiethnic children from a health maintenance organization in Hawaii. Childhood Obesity (Print), 9 (1), doi: /chi Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner, 38 (9), doi: /01.NPR e2