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 epidemic
• Present a childhood obesity epidemiological model
• Explain the role of the APRN in fighting childhood obesity
• Discuss primary, secondary, and tertiary prevention
• Recognize national, state, and local resources
• Identify recommendations for clinical practice
• Provide suggestions for further epidemiological study
Clinical
Definition
• Childhood obesity – a
BMI greater than or equal
to the 95th 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
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_b
Childhood Obesity:
A Serious Health Issue
• Psychosocial problems
• Health Consequences
• 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
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
2007-2009 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 http://www.cdc.gov/obesity/data/childhood.html
Epidemiological Model for
Childhood Obesity
Host
genetics
age
nutrition knowledge deficit
Environment
Causative Agent
limited availability of fruits &
veggies
fast-food marketing
inaccessibility to safe parks &
bike paths
energy dense foods
frequent snacks
large portion sizes
sedentary lifestyle
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 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 support
• Tertiary Prevention – focused on reducing obesityrelated complications and premature death, which
include meal replacement, pharmacological therapy,
and weight loss surgery
National Resources
Program
Organization
Description
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: https://healthymeals.nal.usda.gov
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: http://www.letsmove.gov/
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:
www.nhlbi.nih.gov/health/public/heart
/obesity/wecan/
State & Local Resources
Program
Organization
Description
Fresh Fruit and Vegetable Program
Hawaii 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: http://hcnp.hawaii.gov/overview/
Hawaii 5-2-1-0 Let’s Go!
Hawaii Initiative for Childhood
Obesity Research and Education
This program promotes healthy lifestyles
for children and families. The 5-2-1-0
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 sugarsweetened beverages daily.
Web site: http://www.hawaii5210.com/
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: http://www.npachawaii.org/
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), 14-21. doi:10.1097/01.NPR.0000433074.22398.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), 14-21. doi:10.1097/01.NPR.0000433074.22398.e2
Suggestions for Further
Epidemiological Study
• Obesity in the youth of minority groups
• Obesity in children from a low-socioeconomic status
• Focus on developing effective family-based prevention
interventions for minorities
• Development 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, 424-430. Retrieved from
http://pediatrics.aappublications.org/content/112/2/424.full.pdf+html
Behan, D. F., & Cox, S. H. (2010). Obesity and its relation to mortality and morbidity costs. Retrieved from
www.soa.org/research-2011-obesity-relation-mortality.htm
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: 10.3912/OJIN.Vol14No1Man02
Centers for Disease Control and Prevention. (2011). Healthy weight-it’s not a diet, it’s a lifestyle. Retrieved from
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
Centers for Disease Control and Prevention. (2012). Prevalence of obesity among children and adolescents: United
States, trends 1963-1965 through 2007-2008. Retrieved from
http://www.cdc.gov/nchs/data/hestat/obesity_child_09_10/obesity_child_09_10.pdf
Centers for Disease Control and Prevention. (2013). Public health genomics: Genomics and health. Retrieved from
http://www.cdc.gov/genomics/resources/diseases/obesity/index.htm
Centers for Disease Control and Prevention. (2014). Adolescent and school health: Childhood obesity facts. Retrieved
from http://www.cdc.gov/healthyyouth/obesity/facts.htm
Choudhary, A. K., Donnelly, L. F., Racadio, J. M., & Strife, J. L. (2007). Disease associated with childhood obesity.
American Journal of Roentgenology, 188(4), 1118-1130. Retrieved from
http://www.ajronline.org/doi/full/10.2214/AJR.06.0651
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), 418-427.
doi:10.1016/j.amepre.2009.07.012
Hawaii Department of Health. (2012). State of Hawaii primary care needs assessment data book 2012. Retrieved from
http://health.hawaii.gov/about/files/2013/06/pcna2012databook.pdf
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
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a health maintenance organization in Hawaii. Childhood Obesity (Print), 9(1), 35-42. doi:10.1089/chi.2012.0103
Sorg, M. J., Yehle, K. S., Coddington, J. A., Ahmend, A. H. (2013). Implementing family-based childhood obesity
interventions. The Nurse Practitioner, 38(9), 14-21. doi:10.1097/01.NPR.0000433074.22398.e2