Casey Wagner, RN, BSN
UAB PPC Nursing Trainee
April 21, 2010
 Explain
the gravity that the childhood obesity
epidemic has on Child Health.
 State the physiological imbalance that causes
overweight and obesity.
 Name three psychosocial factors that
contribute to overweight and obesity in
children.
 Describe one piece of evidence that a weight
management camp is effective in treating
childhood obesity.
 Childhood
Obesity
 Current Evidence-based Treatment Strategies
 Gaps in the Literature
 Children’s Health System of Alabama Clinic for
Weight Management (CCWM)
 CCWM Camp S.H.I.N.E.
 Casey’s Evidence-Based Practice Project:
Parental Involvement Program (PIP)
Childhood Overweight and Obesity
 Obese
children and
adolescents are at
risk for health
problems during
their youth and as
adults
 Obese children and
adolescents are more
likely to become
obese as adults
(Centers for Disease Control & Prevention, 2009)
 For
children and adolescents (aged 2–19
years), the BMI value is plotted on the CDC
growth charts to determine the corresponding
BMI-for-age percentile.
 Overweight is defined as a BMI at or above the
85th percentile and lower than the 95th
percentile.
 Obesity is defined as a BMI at or above the 95th
percentile for children of the same age and
sex.
[(Barlow SE & the Expert Committee, 2007) &
(Centers of Disease Control and Prevention, 2009)]
 31.7%
of children
and adolescents ages
2-19 years are
overweight
 17 % of children and
adolescents ages 219 years are obese
 11.9% are at or above
the 97th percentile of
the BMI-for-age
growth charts
[(Ogden et al., 2010) from
(NHANES, 2007-2008)]
 BASICALLY, people
become overweight
when they CONSUME TOO MANY
calories (eating and digesting) and
EXPEND TOO FEW calories (sedentary
activities and lack of exercise)
 BUT… what causes these behaviors?




This model recognizes the
interwoven relationship that
exists between the individual
and their environment
Individuals are responsible but
behavior is determined to a
large extent by social
environment
Barriers to healthy behaviors
are shared among the
community
The most effective approach is
a combination of efforts at all
levels
(Wilson, 2001)
Weight Management for Pediatric Patients
According to Gillis et al. (2005), research suggests
children already in enrolled in a weight
management program will gain weight in summer
months when compared to weight gain in the other
seasons of the year
 Retrospective cohort study with 73 participants
from the pediatric wt. mgmt. center in Ontario,
Canada
 Implications: Develop ways to deal with summer
vacation period for obese children and
adolescents!
 Also, authors suggest that families need to be
aware and involved

 Depends
on what
you’re looking at…
• Study’ s
measurements
• Type of camp
• Cost
 8-week
multi-disciplinary residential summer
camp
 1700 calorie/day diet, daily calisthenics
workouts, resistance weight training, integrated
sports activities, nutrition classes, and weekly
sessions with a psychologist
 Short-term Results: an average of 8.3% BMI
reduction, circumference measurements
decreased
 Physical ability did not increase significantly
 High price tag = approximately $1,000/wk
(Cooper et al., 2006)
 8-week
residential camp, also in North Carolina
 1,800 calorie/day diet, nutrition class 2/wk,
cooking class 1/wk, 1-hour physical activity
sessions 5/day, weekly psychosocial group
 Findings:
• Length of stay correlated significantly with
weight loss
• decreased anti-fat attitudes and value placed on
appearance
• increased body esteem, self-esteem, and
weight/eating efficacy
 6-week,
residential camp at a boarding
school’s facilities
 Dietary restriction based on metabolic rate, 6
1-hour physical activity sessions/day, and 4
education sessions/week
 Results = ↓ body mass, BMI, body fat, and waist
and hip circumference with statistical
significance and ↑ self-esteem, sports skills
 Greater improvement with longer duration of
stay
(Gately et al., 2005)
Camp literature doesn’t explore parental involvement
 Aim:
To determine contributions of family and
neighborhood environments on changes in
youth physical activity and BMI over 5 years
 Methods: Longitudinal cohort study of 10- to 12year olds in Melbourne, Australia
 Results: Physical activity ↓ and BMI z-score ↑
over the 5 years
• Factors in the home environment were more often
associated with physical activity and BMI than either
perceived or objective measures of the local
neighborhood environment
(Crawford et al., 2010)

Story et al. (2002) report  the most frequent
barriers cited by practitioners overall were:
• lack of parent involvement
• lack of patient motivation
• lack of support services
Data from a large national survey of pediatricians,
PNPs, and RDs to evaluate attitudes, assessment
methods, and treatment practices in the
management of childhood obesity
 Reiterates that there is critical need for exploring
strategies to reduce barriers in treatment of
obesity

Stages of Change Model



(Rhee et al., 2005)
Aim: describe demographics
and parental perceptions
associated with readiness to
make weight-reducing lifestyle
changes for their overweight
children
Findings: 38% preparation or
action, 17% contemplation,
and 44% precontemplation
Parents who thought their
child’s weight was a health
problem had 16x the odds of
being in preparation/action
After an exhaustive review, no studies were found that examined
parental involvement in residential weight management camp.
 6-week
program attended by 12-15 y.o. with
obesity - weekly parent education groups
 Program did not have explicit goal of weight
loss
• Included exercise, field trips, nutrition class,
cooking & shopping groups, trips to
supermarkets and restaurants, behavioral
therapy group, art therapy, and yoga
 No
significant changes in anthropometrics, lab
values, eating behaviors, or family functioning
 Improvements in quality of life, the stages of
change, and ↑ physical activity
(Kotler et al., 2006)
 Framework:
lifestyle enhancement and family
involvement would improve children’s health
 Aim: evaluate the effects of a hospital-based,
family-centered lifestyle program on weight
and health in overweight 7-17-year-olds
 Intervention: 12 90-minute sessions held
1x/week at local children’s hospital
 Results: significant  in BMI, child perceived
health & function, improved family cohesion
(Dreimane et al., 2007)
Aim: To develop and test the
feasibility and acceptability of
HOME program, a pilot
childhood obesity prevention
program aimed at increasing
quality foods in the home
environment and during
family meals
(Fulkerson et al., 2010)
Results:
 86% of families attended at
least four of the five sessions
 Parents and children were
very satisfied with the
program
 Children significantly more
likely to report improved
food preparation skill
 Trends suggesting that
intervention children had
higher consumption of fruits &
vegetables, ↑ intake of key
nutrients
Birmingham and Central Alabama’s treatment program for
childhood overweight and obesity
http://weight.chsys.org/
 Interdisciplinary
focus: Pediatrician, Surgeon,
RN, PNP, RD, PT, & Psychologist
 Long wait to get 1st appointment (~8 months)
 Goal: assist families in making permanent
behavior changes that result in weight loss,
improved health, & greater sense of well-being
CCWM’s summer camp

Pilot a 1-week, residential
weight management summer
camp program with
comprehensive educational
offerings, focused on healthy
eating and physical activity,
for overweight children and
their families, and evaluate
the positive health and
psychological effects
 Will
a Parent Involvement Program (PIP),
designed to engage & educate parents of camp
attendees, improve parents’:
• Readiness to Change,
• Self-Perceived Progress towards Healthy
Lifestyle Goals,
• Perceptions of Child’s Quality of Life?
 Participants
will be overweight children,
aged 10- to 14-years old, and their
parents
 Recruitment through the patients of
CCWM with appointments in the last year
or who are on the waiting list
 Exclusion Criteria: Children with a
developmental delay, physical limitation,
or are not fluent in English
 Randomized control trial, with n = 15 for
intervention and control group
 Camp
Kick-Off educational session on Sunday
afternoon with parents
 Mid-week phone call during camp
 End of Camp session on Saturday
 Administer the Child Behavior Checklist,
Impact of Weight on Quality of Life- Parent
form, Readiness to Change tool, & Project Eat
Survey before camp and 1 month post camp
 Administer the PIP Goals Survey at kick-off and
1 month post camp
1. It is important to set goals for a healthy life. Please use
this pack of cards to rank your goals for your home.
Label the back of each card with a number, with 1 being
the most important to you and 10 being the least
important. If none of the listed matches your top personal
goal, use the wild card to write it in.
2. On a scale of 1 to 10, how close are you to reaching your
top goals? (1 = Very far; 10= Goal Met)
3. Please use the second pack of cards to rank the top barriers
to reaching your goals. Label the back of each card with a
number, 1 being the top barrier to you and your family, and 10
being the least of a barrier. If none of the listed matches your
top barrier, use the wild card to write it in.
4. On a scale of 1 to 10, how confident are you that you and
your family can make progress towards reaching the goals?
(1= Not at all; 10= Very much)
5. On a scale of 1 to 10, how important is it to you to reach
your goals? (1= Not at all; 10= Very much)
CAUTION:
CASEY AT
WORK

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
Strategies discussed
today could be applied
to the care of children
with many, various
chronic health care
needs
Ideal  Programs with
Family-Centered Care &
Parental Involvement
Must consider the
theories of the SocioEcological Model,
Behavior Change
THANK YOU VERY MUCH!