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Childhood Obesity and the Link to Diabetes
Anita Wheeler, RN, MSN
Department of State Health Services
Health Promotion and Chronic Disease Prevention Section
School Health Coordinator/School Nurse Consultant
anita.wheeler@dshs.state.tx.us
Learning Objectives
• Define the terms overweight and obesity.
• Describe three health consequences of childhood obesity.
• Identify at least two nursing interventions that can be implemented in schools to address obesity and prevent Type 2 diabetes.
• Develop an Individualized Health Care plan that includes nursing outcomes for weight management and physical fitness.
Page 2
2
Update on Change in Definition of Obesity and Overweight
• Texas has established a surveillance system, School Physical Activity and Nutrition (SPAN), to monitor the prevalence of overweight/obesity in school-aged children.
• The information below helps in understanding the next slides about SPAN data.
• There was a change in the definitions of overweight and obesity among children and adolescents (17 years and younger) since 2007.
• These changes were implemented in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and co-funded by AMA in collaboration with the Health Resources and Services Administration and the CDC.
Page 3
Definition As categorized before 2007 As categorized 2007 and later
BMI ≥ to 95th percentile for age and sex
Overweight Obese
BMI ≥ 85th percentile and < 95th percentile for age and sex
At risk for overweight Overweight
Percentage of U.S. Children and Adolescents Classified
as Obese, 1963–2008*
Page 4
•*>95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts.
•**1963–1970 data are from 1963–1965 for children 6–11 years of age and from 1966–1970 for adolescents 12–17 years of age.
•Source: NCHS. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011
•4.6
•4.2
•19.6
•18.1
3
Page 5
0
5
10
15
20
25
1963–1965, 1966–1970
1971–1974 1976–1980 1988–1994 1999–1900 2001–2002 2003–2004 2005–2006 2007–2008
Per
cen
tag
e
Prevalence of obesity among U.S. children and adolescents aged 2–19, for selected years 1963–1965 through 2007–2008
Total
2–5
6–11
12–19
Data Source: NHES 1963-1965 and 1966-1970 and NHANES from 1971-2008.Data for 1963–1965 are for children aged 6–11; data for 1966–1970 are for adolescents aged 12–17, not 12–19 years. Children aged 2–5 were not included in the surveys undertaken in the 1960s.http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf
11th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,
2000-2002 to 2004-2005
Page 6
*Overweight is > 95th Percentile for BMI by Age/Sex
2000-2002 2004-2005
Note: As explained in the previous slide the definition of overweight before 2007 was ‘> 95th Percentile for BMI by Age/Sex’ which is now categorized as obese.
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Prevalence of Obesity among 11th Graders by Health Service Region, SPAN 2009-2011
8th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,
2000-2002 to 2004-2005
Page 8
*Overweight is > 95th Percentile for BMI by Age/Sex
2000-2002 2004-2005
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Prevalence of Obesity among 8th Graders by Health Service Region, SPAN 2009-2011
4th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,
2000-2002 to 2004-2005
Page 10
*Overweight is > 95th Percentile for BMI by Age/Sex
2000-2002 2004-2005
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Prevalence of Obesity among 4th Graders by Health Service Region, SPAN 2009-2011
Obesity In High School:Texas and the U.S., 2001-2009
Page 12
Prevalence of High School Students Who Were Obese (At or Above the 95th Percentile for BMI by Age and Sex)
2001, 2005, 2007, 2009 YRBSTexas vs. United States
14.2 13.9 15.9 13.610.5 13.1 13.0 12.00.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
2001 2005 2007 2009
Per
cent
age
Texas US
HP2010 Target
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Obesity In High School:Trend in Texas and the U.S., 1999-
2009
14.2% 13.9%
15.9%
13.6%
10.7% 10.5%
12.1%13.1% 13.0%
12.0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1999 2001 2003 2005 2007 2009
Pre
val
ence
Year
Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2009
Texas
US
Page 13
Obesity In High School:Trend in Texas and the U.S., 1999-2011
14.2% 13.9%
15.9%
13.6%
15.6%
10.7% 10.5%
12.1%13.1% 13.0%
12.0%13.0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1999 2001 2003 2005 2007 2009 2011
Pre
val
ence
Year
Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2011
Texas
US
8
Obesity In High School: U.S. 2005-2011
Page 15
2005 2007
2009 2011
Obesity in High School:By Race and Ethnicity
Page 16
Prevalence of High School Students Who Were Obese (At or Above the 95th Percentile for BMI by Age and Sex) by Race/Ethnicity
2001, 2005, 2007, 2009 Texas YRBS
10.9 10.2 13.8 10.017.3 18.0 14.6 16.717.6 16.9 19.2 16.58.0 7.5 15.2 7.60.0
5.0
10.0
15.0
20.0
25.0
30.0
2001 2005 2007 2009
Per
cen
tag
e
White Black Hispanic Other
HP2010 Target
9
Obesity in High School:By Race and Ethnicity, Texas 2001-2011
10.9 10.2 13.8 10 10.217.3 18 14.6 16.7 16.417.6 16.9 19.2 16.5 19.28 7.5 15.2 7.6 14.10
5
10
15
20
25
30
2001 2005 2007 2009 2011
Per
cen
tag
e
Prevalence of Obesity among High School Students:By Race and Ethnicity, Texas 2001-2011
White Non-Hispanic African-American Non-Hispanic Hispanic Other
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ObesityNot just an adult concern anymore…
Conditions Seen in Children• High Cholesterol
• Type 2 Diabetes/Impaired Glucose Tolerance
• High Blood Pressure
• Social Problems andPoor Self-Esteem
• Sleep Disturbances
• Orthopedic Problems
Page 19
Obese children and adolescents are more likely to become overweight or obese adults
• Heart Disease• Cancer• Stroke• Type 2 Diabetes• Osteoarthritis• Physical Disability• High Blood Pressure• Sleep Apnea
Page 20
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Factors Contributing to Obesity
Genetics
Environment
Unhealthy Diet
Sedentary Lifestyle
Lack of Physical Activity
Page 21
School Environments
School Food Environment
Low-nutrient, energy-dense foods and beverages are
• Served in vending machines, à la carte lines, school stores, fundraisers, and classroom parties.
• Marketed to students.
(cont.)Page 22
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School Environments
School Physical Activity Environment
• Daily physical education is not provided in most schools.
• Daily recess for elementary school students is not offered at many schools.
• Walking or biking to school is less common.
Page 23
SchoolHealth
Guidelines
1. Policies and Practices
2. School Environments
3. Nutrition Services
4. Physical Education andPhysical Activity
5. Health Education
6. School Health Services
7. Family and Community
8. School Employee Wellness
9. Professional Development
Page 24
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Policies and Practices
School Health
Council
School Health Team
School Health
Coordinator
Assess*
Develop and Implement
Evaluate
Page 25
•* Using the School Health Index (www.cdc.gov/HealthyYouth/SHI)
GUIDELINE 1
School Health
Council
Coordinated School
Health Team
School Health
Coordinator
Family and Community
Promote Communication and Involvement
Page 26
Schools
• Families• Community
Members
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School Health Services
ASSESS
REFER
ADVOCATE
Page 27
•Health Services
•Mental Health•Services
•Social•Services
•STAFF
NANDA Nursing Diagnosis(These are just the basic ones)
• Altered nutrition: intake exceeds the body’s needs
• Impaired physical mobility
• Deficit recreation
• Knowledge deficit related to (nutrition, physical activity)
• Chronic low self-esteem or Disorder of low self-esteem
• Social isolation
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Nursing Intervention Classifications (NIC)
• Comprehensive
• Research based
• Reflects current clinical practice
• Easy to use (Domains, Classes, Interventions, Activities all have definitions)
• Uses language that is clear and meaningful
• Continually updated
• Field tested
Page 29
Possible Nursing Interventions
• Behavior modification (4360)
• Body image enhancement (5220)
• Emotional support (5270)
• Family involvement promotion (7110)
• Health education (5510)
• Journaling (4740)
• Nutrition management (1100)
• Program development (8700)
• Teaching: activity/exercise (5612)
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Exercise Promotion (0200)
• Appraise beliefs
• Explore prior experiences
• Determine motivation
• Explore barriers
• Encourage verbalization
• Encourage to begin or continue exercise
• Assist in finding positive role model
• Assist in setting short and long term goals
• Include family in planning
• Inform about health benefits
• Instruct on frequency, duration, and intensity
• Monitor adherence
• Help in preparing progress chart
• Instruct on proper warm up and cool down
• Monitor response to program Page 31
Nursing Outcome Classifications
• Developed inductively and deductively
• Grounded in clinical practice and research
• Uses clear, useful language
• Helps in organizing outcome measures
• Outcomes can be shared by all disciplines
• Optimizes information for evaluation of effectiveness.
• Funded by the National Institute of Nursing Research
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Nursing Outcome Measures
• Knowledge-diet (1802)
• Compliance Behavior: Prescribed diet (1622)
• Knowledge-Weight management (1841)
• Physical Fitness (2004)
Page 33Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9
Page 34
Knowledge: Diet- (1802)
Knowledge: Diet Overall Rating
No Knowledge1
Limited Knowledge
2
Moderate Knowledge
3
Substantial Knowledge
4
Extensive Knowledge
5
Not ApplicableN/A
Indicators:Recommended diet
1 2 3 4 5
Rationale for diet 1 2 3 4 5
Dietary goals 1 2 3 4 5
Relationship among diet, exercise and weight
1 2 3 4 5
Interpretation of food labels 1 2 3 4 5
Strategies to change dietary habits
1 2 3 4 5
Self-monitoring techniques 1 2 3 4 5
Outcome Target Range: Maintain at ______ Increase to _____
Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9
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Individualized Healthcare Plan
Page 35
• Nursing Assessment• Nursing Diagnosis• Planning Care Utilizing Nursing Interventions
and Outcome Classifications• Implementation• Evaluation
Constructing a Nursing Care Plan
Page 36
Assessment Nursing Diagnosis Planning (NIC and NOC)
Implementation Evaluation (NOC Completed)
Height Weight Calculate BMIB/P
Family History FitnessGram dataFood diaryPhysical activity log
Other Assessment Information
1) Altered nutrition:intake exceeds thebody’s needs
2) Activity intolerance3) Impaired physical
mobility4) Knowledge
deficit/nutrition or physical activity
5) Activity intolerance or high risk of intolerance
6) Sleep pattern disturbance
7) Recreation deficit8) Social isolation
1) Promotion of Behavior Change
2) Body Image Enhancement
3) Emotional Support4) Exercise Promotion5) Family Involvement
Promotion6) Health Education7) Journaling8) Nutrition Management9) Nutritional Counseling10) Program
Development11) Teaching: Prescribed
Activity/Exercise
• Should outline who you will be collaborating with, if applicable.
• Also should outline specific timeline for implementation.
• Should outline the steps of implementation.
Example: Knowledge: Diet-1802
Rational 1 2 3 4 5 N/AAdvantages 1 2 3 4 5 N/ADietary Goals 1 2 3 4 5 N/AInterpretation
Food Labels 1 2 3 4 5 N/AStrategies to
Change 1 2 3 4 5 N/ASocial Situations 1 2 3 4 5 N/ASelf-monitoring
Techniques 1 2 3 4 5 N/A
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Page 37
National Association of School Nurses (Online Courses)Childhood Overweight and Obesity: Overview
1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)
Evidence-based Practice1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)
School Nurse Leadership: Advocating for Change1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)
Height/Weight and BMI Screening, Resources and Interventions1.0 CNE Contact Hour/moduleFree to NASN Members! (Non-member price: $15.00)
Acanthosis Nigricans - School Nurse Educational Program1.0 CNE contact hourFree for all audiences!
Texas Health Step Modules (Free CEs) http://www.txhealthsteps.com/cms/ObesityExercise Induced AsthmaOther Child Health Topics
Training and Resources
Resources
• DSHS-Diabetes Council Algorithms
http://www.tdctoolkit.org/download_a_tool_kit.asp
• DSHS-Diabetes Main Page
http://www.dshs.state.tx.us/diabetes/
• DSHS-Obesity Prevention (Videos)
http://www.dshs.state.tx.us/obesity/GrowingCommunity.shtm
• DSHS-Nutrition, Physical Activity and Obesity Home Page
http://www.dshs.state.tx.us/obesity/NPAOPprogrampage.shtm
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Contact Information
Anita Wheeler, RN, MSNSchool Health Coordinator/School Nurse Consultant
512-776-2909
anita.wheeler@dshs.state.tx.us
Page 39
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