1. Childhood Obesity Lisa Cabrera, Katherine Ko & Kathryn Pugh

2. Are We SUPERSIZING Our Children?...Yes!!!

3. Supersized Prevalence Rates ● Over the past 30 years obesity rates have more than doubled in children and quadrupled in adolescents in the united states. ● The percentage of obese children ages 6–11 years in the United States has risen from 7% in 1980 to nearly 18% in 2012; additionally, the percentage of obese adolescents ages 12–19 years increased from 5% to nearly 21% in the same time span. ● In 2012, more than one third of children and adolescents were either overweight or obese in the United States. ● From 2011-2012, obesity prevalence was higher among Hispanics (22.4%) and African Americans (20.2%), than non-Hispanic white youth (14.1%). ● Obesity prevalence among children whose adult head of household completed college was approximately half that of those whose adult head of household did not complete high school. (CDC, 2014)

4. ●In 2012, approximately 170 million children were overweight or obese worldwide. ● Obesity is now the 5th leading risk factor for mortality worldwide. ● Middle to upper income countries have the highest prevalence rates of overweight and obese children; and low income countries have the lowest rates. Low to middle income countries have the fastest growing prevalence rates of childhood obesity. ● As low and middle income countries rapidly grow, and their populations become more urban and globalized, lifestyle and diet changes have increased obesity rates. (WHO, 2012) Global Epidemic

5. Childhood Obesity ● Overweight: having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors; children are considered overweight if they fall between the 85th-95th percentile on standard pediatric growth charts. ● Obesity: an increase in body weight resulting from an excess accumulation of body fat relative to lean body mass; children are considered obese if they fall into the 95th percentile or above, on standard pediatric growth charts. ● Morbid Obesity: more than 1.2 times the 95th percentile on standard pediatric growth charts. (Hockenberry & Wilson, 2013)

6. Etiology and Pathophysiology Obesity results from caloric intake that consistently exceeds requirements and expenditures and involves both genetic and environmental influences that include: ● Diet: high calorie, high sugar, high fat diet ● Lack of physical activity: sedentary lifestyle, TV watching, video games, social media ● Hypothalamic disorders: hypothyroidism, hypercorticoidism, hyperinsulinemia ● Heredity: 35-50% of the tendency toward obesity is inherited ● Socioeconomic factors: limited financial ability to pay for, and accessibility of, high quality foods, proximity and accessibility of fast food restaurants and low quality foods ● Cultural factors: cultural eating patterns, large portions, admonishing child if all food on plate is not eaten, parents may have an exaggerated idea about amount of food a child requires for optimal health ● Psychological factors: food as a source of comfort, positive reinforcement, and reward (Hockenberry & Wilson, 2013)

7. Impact on Health Childhood obesity increases the risk of developing the following weight-associated health conditions: ● Elevated blood cholesterol ● Respiratory disorders ● Orthopedic conditions ● Non-alcoholic fatty liver disease ● Type-II diabetes (insulin resistance) (Hockenberry & Wilson, 2013) ● Cardiovascular disease ● Hypertension ● Cholelithiasis ● Certain types of cancers ● Sleep disorders (apnea)

8. Psychosocial Impact ● Poor body image ● Low self-esteem ● Social isolation (Hockenberry & Wilson, 2013) ● Feelings of rejection ● Depression ● Low self-efficacy (Hockenberry & Wilson, 2013)

9. Long Term Impact on Society — Direct medical spending ●Annual direct costs of childhood obesity: 14.3 billion ●US-wide annual cost of “excess” medical spending attributable to obesity: $86–$147 billion — Productivity costs ● Absenteeism: $3.38–$6.38 billion ●Presenteeism (relative productivity loss due to obesity): $8 billion ●Disability Rates: 5.64–6.92 percentage points higher due to obesity ●Premature mortality (years of life lost due to obesity): 1–13 years — Transportation costs ● Fuel costs: Air travel -$742 million and Ground transportation- $2.53–2.7 billion — Human capital accumulation costs ● Highest grade completed: 0.1–0.3 fewer grades completed ● Days absent from school: 1.2–2.1 more days absent from school(CDC, 2014)

10. Nursing Implications Nurses have a professional and moral obligation to advocate for social changes that promote healthy lifestyles, particularly for vulnerable populations such as children, the disabled, and persons living in poverty. Nurses can partner with patients and families in implementing tailored weight control or weight loss behaviors, including: ● Encouraging nutritious diets that are high in vitamins and minerals from fruits and vegetables, low in fat and include whole grains rather white flour. ● Encouraging families to avoid sedentary behavior, especially the television and computer, for more than 2 hours a day. Alternatively, they should be involved in enjoyable, developmentally appropriate physical activity for 1 to 2 hours daily. ● Teaching parents the basics of nutrition, including appropriate portion sizes, label-reading skills, food preparation, and "healthy" grocery shopping. ● Helping families become sensitized to the food industry's strategies by increasing parents' awareness about the marketing tactics used with children and the lack of regulation for advertising to children. ● Advocacy for obesity prevention in clinical and school environments (Budd & Hayman, 2008)

11. Nursing Implications School nurses are charged with the task of health promotion and disease prevention within the school setting and are well suited to address obesity prevention. ● Identify overweight and obese children through BMI screenings. ● Provide counseling and resources to the families of overweight and obese children. ● Work with school administrators, teachers, and parents to advocate for and implement evidence-based school policies related to obesity prevention. (Rabbitt & Coyne, 2012)

12. References Budd, G., & Hayman, L. (2008). Addressing the childhood obesity crisis: a call to action. MCN: The American Journal Of Maternal Child Nursing, 33(2), 111-120. Centers for Disease Control and Prevention. (2014). Childhood obesity facts. Retrieved from http://www.cdc.gov/obesity/data/childhood.html Hockenberry, M. J. & Wilson, D. (2013). Wong’s essentials of pediatric nursing. (9 th ed.). St. Louis, MO: Elsevier/Mosby. Rabbitt, A., & Coyne, I. (2012). Childhood obesity: nurses' role in addressing the epidemic. British Journal of Nursing, 21(12), 731-735. World Health Organization. (2012). Childhood obesity prevention. Retrieved from http://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION _27nov_HR_PRINT_OK.pdf