Childhood Obesity: A Growing EpidemicHolly Ehrke

Keri Ivan

Yvonne Robles

Andrea Scott

Why School Wellness?

Schools play an important role in restructuring social and physical environments.

Schools are the ideal setting for teaching healthy lifestyles. More than 95% of young people are enrolled in schools.

Many students eat breakfast and lunch at school.

Students have the opportunity to be physically active at school.

National Center for Chronic Disease Prevention and Health Promotion, division of Adolescent and School Health.

(November 12, 2008). Healthy youth! Make a difference: Key strategies to prevent obesity. Retrieved from http:/www.cdc.gov/HealthyYouth/keystrategies/shy-schools.htm

School Wellness Link to Academic Outcomes

The National Association of State Boards of Education (NASBE) has written:

“Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.”

National Association of State Boards of Education. (December 2004). Fit, healthy, and ready to learn: Part 1: Physical activity, healthy eating, and tobacco-use prevention. Retrieved from http://www.cdc.gov/Healthy

Youth/physicalactivity/pdf/roleofschools_obesity.pdf

Impact of ObesityIncreasing at an ALARMING rate!

Health care costs.

Serious health impacts.

National Center for Chronic Disease Prevention and Health Promotion. (March 31, 2010). Overweight and obesity.

Retrieved from http://www.cdc.gov/obesity/childhood/index.html

Increasing Rate of ObesitySince 1980, the rate has more than doubled for 6-11 year olds (6.5% to 19.6%) and has more than tripled for adolescents (5% to 18.1%).

2007 Child Obesity rates – Michigan’s is 30.6%

National Center for Chronic Disease Prevention and Health Promotion. (March 31, 2010). Overweight and obesity.

Retrieved from http://www.cdc.gov/obesity/childhood/index.html

National Conference of State Legislatures. (2011). Childhood obesity and overweight trends. Retrieved from

http://www.ncsl.org/?tabid=13877

2003 Child Obesity Rates – Michigan’s is 14.5%

Health Care Costs

Obesity-associated annual hospital costs among youth have tripled from $35 million in 1979-1981 to $127 million in 1997-1999.

According to Katie Couric in a CBS News report, $100 billion dollars are spent annually on health care needs related to obesity.

American Academy of Child and Adolescent Psychiatry. (May 2008). Obesity in children and teens. Retrieved

from http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens

CBS News. (September 20, 2007). Katie Couric’s notebook: Obesity in America (CBS News). Retrieved from

http://www.youtube.com/watch?v=P_1u_RVaULE&NR=1&feature=fvwp

National Center for Chronic Disease Prevention and Health Promotion. (March 31, 2010). Overweight and

obesity. Retrieved from http://www.cdc.gov/obesity/childhood/index.html

Serious Health Impacts

U.S. Surgeon General: “the U.S. Surgeon General has identified the obesity epidemic as one of the greatest health problems facing the nation today,”

Diseases in Children: Type 2 diabetes

Heart disease – “61% of obese 5-to 10-year-olds already had risk factors for heart disease, and 26% had two or more risk factors for the disease”

Social and psychological problems – at risk for discrimination and poor self-esteem

Obese for life – 70% chance of becoming obese adults

National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School

Health. (November 12, 2008). Healthy youth! Make a difference: Key strategies to prevent obesity.

Retrieved from http://www.cdc.gov/HealthyYouth/keystrategies/why-schools.htm

Causes of Obesity in ChildrenLess than one percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

Poor eating habits

Overeating or binging

Lack of exercise (i.e. couch potato kids)

Increased screen time (TV, computers, video games, cell phones)

Decreased amount of physical education classes in school

Kids no longer walk to school

American Academy of Child and Adolescent Psychiatry. (May 2008). Obesity in children and teens. Retrieved from

http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens

Michigan Statistics

• In 2007, 28.9% of Michigan youth, grades 9th through 12th, were either overweight or obese; 16.5% were overweight and an additional 12.4 % were obese.

• The prevalence of obesity among Michigan youth has increased slightly from 10.9% in 1999 to 12.4% in 2007.

• In 2007, 14.0% of low-income children, 2 to 4 years, were obese.• In 2005, 33.1% of Michigan youth did not meet the recommended amount of

physical activity.• In 2005, 10.7% of Michigan youth reported no physical activity in the last seven

days.• In 2007, the prevalence of excessive TV viewing among youth in Michigan was

32.6%.• In the past nine years, the prevalence of Michigan youth that have not met the

minimum recommendations for fruits and vegetables fluctuated from 81.0% in 1999 to 83.0% in 2007.

• In 2007, the prevalence of Michigan youth that drank at least one pop per day (28.9%) was lower than the United States youth (33.8%) prevalence.

• Currently, the total number of Michigan youth ages 10-17 who are overweight and obese are 18.2% and 12.4% respectively compared to the national percentages of 15.3% and 16.4% respectively.

Centers for Disease Control and Prevention. (February 14, 2011). Division of nutrition physical activity and

obesity. Retrieved from http://www.cdc.gov/nccdphp/dnpa/index.html

Healthy Kids, Healthy Michigan. Retrieved from http://www.healthykidshealthymich.com/hkhm-

presspreleases.html

BMI Table for Children Ages 2-19

Weight Status Category Percentile Range

Underweight Less than the 5th percentile

Healthy weight5th percentile to less than the 85th percentile

Overweight85th to less than the 95th percentile

ObeseEqual to or greater than the 95th percentile

BMI-for-age weight status categories and the corresponding percentiles are shown in the following table.

Body mass index-for-age percentiles: using a 10 year old boy with different BMIs as an example.

Centers for Disease Control and Prevention. (February 15, 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

Statistics for Cheboygan County

The obesity proportion is 30.8%

In 2008, 18.2% of the population was living below the poverty line. The state average at this time was 14.4%.

Unemployment Rate – 13.8%

Low-income preschool obesity rate: Cheboygan County: 14.8%

State of Michigan: 13.4%

City-Data.com. (2010). Cheboygan County, Michigan (MI). Retrieved from http://www.city-data.com/

county/Cheboygan_County-MI.html

Michigan Department of Community Health. (2010). Michigan community health information. Retrieved

from http://www.mdch.state.mi.us/pha/osr/chi/IndexVer2.asp

U.S. Census Bureau (2009). State and county quick facts. Retrieved from http://quickfacts.census.gov/

qfd/states/26/26031.html

Local Barriers to Cheboygan Middle School Rural setting: Transportation to school is by bus or

private vehicle.

No sidewalks lead up to the school.

Lack of education: there is not any type of obesity program set up at the school (L. Chase, personal communication, February 22, 2011).

School nutrition USDA reimbursable school breakfast or lunch program: 63-

67% of the student population participates in this (L. Chase, personal communication, February 22, 2011).

Foods with minimal nutritional value.

Lack of fitness facilities within the community.

Ehrke, H. (January 28, 2011). NURS 340 Windshield Survey of Cheboygan County

Diagnosis

Risk of Obesity among middle school students in Cheboygan county related to inadequate nutrition and lack of physical activity as demonstrated by the doubling of the obesity rate among children between 2003 and 2007 and a 30.8% obesity rate for Cheboygan County.

GoalPromote a learning of lifelong health habits that will reduce the prevalence of obesity in school-aged children in the 5th and 6th grades at the Cheboygan Middle School by May 15, 2012 as demonstrated by the reduction in the county obesity rate.

Objectives 90% of students in the 5th

and 6th grade will participate in obesity/nutrition program implemented at the Cheboygan Middle School by May 15, 2012.

50% of students who have been identified as overweight or obese will demonstrate a decrease in BMI by 5% by May 15, 2012.

50% of students will report physical activity of thirty minutes or more per day by May 15, 2012.

50% of students will report eating 5 servings of fruits and vegetables per day by May 15, 2012.

Interventions for Objective 1 Form a health education team of three parents, two teachers,

one health education instructor, four students and a public health nurse by September 30, 2012.

All parents/guardians of 5th and 6th graders will receive letter of introduction and consent form regarding obesity and nutritional program by September 15, 2011. Evidence Based Practice: “ Families should be educated and

empowered through anticipatory guidance to recognize the impact they have on their children’s development of lifelong habits of physical activity and nutritious eating” (Krebs & Jacobson, 2003, p. 427).

Health education instructor will keep attendance records of 5th and 6th graders that participate in obesity/nutrition program implemented at the Cheboygan Middle School and will give attendance records to public health nurse by May 1, 2012.

Krebs, N. F., & Jacobson, M. S. (2003). Prevention of pediatric overweight and obesity. Pediatrics, 112(2), 424-430. Retrieved

from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424#SEC7

Peterson, K. E., & Fox, M. K. (2007). Addressing the epidemic of childhood obesity through school-bases interventions:

what has been done and where do we go from here: Journal of law, medicine & ethics, 35(1), 113.

Evaluation for Objective 1

The public health nurse will compile attendance logs during the 2011-2012 school year and will calculate participation rate according to class roster at the Cheboygan Middle School by May 15, 2012.

Interventions for Objective 2

Parent volunteers will obtain the weight and height of each 5th and 6th grade student at Cheboygan Middle School during none core course, such as band or gym by October 15, 2011 to determine baseline BMI’s.

Parent volunteers will obtain the height and weight of each 5th and 6th grade student by May 15, 2012 to determine post-education and implementation BMIs and to calculate gains and/or losses.

Evidence Based PracticeThe article, Integrative Review of School-based Childhood Obesity Prevention Programs, was an integrative review of sixteen comparison studies on childhood obesity school-based prevention programs. The review examined nursing interventions: dietary, physical activity, healthy lifestyle education, and/or parental involvement. The review also examined the variations in the duration of the interventions; whether the interventions were guided by the use of a theoretical framework; the strength of evidence supporting the studies; and whether the interventions demonstrated a reduction in body mass index or weight loss.

Eight of the 16 studies (50%) applied theoretical frameworks. Four studies (25%) utilized the Transtheoretical Model. The Transtheoretical Model is conceptualized as a process in which change in behavior transitions through five stages: precontemplation, contemplation, preparation for action, action, and maintenance (Prochaska & Norcross, 2001). Pender’s Health Promotion Model was applied to both studies by Frenn and associates (2003). The Health Promotion Model is based on nursing and behavioral approaches that are meant to assist individuals in making positive behavioral changes (Pender, Murdaugh, & Parsons, 2002).

Evidence Based Practice ContinuedAdvanced Nurse Practitioners (APNs) are in a unique position to implement school-based obesity prevention programs. They focus nursing interventions, such as lifestyle changes that may decrease the incidence of obesity and ultimately prevent the comorbidities that are associated with obesity, such as cardiovascular disease, type II diabetes, and psychiatric disorders ([Freedman et al., 1999] and [Manus and Killeen, 1995]).

In conclusion, it was found that most effective school-based obesity intervention programs benefit by using theoretical frameworks. Research concluded that interventions that included dietary habit modification, physical activity modification, healthy lifestyle education, and parental involvement were the most successful. Also, BMI was found to be an effective measurement of outcomes.Zen, W, & Suha, K. (2008). Integrative review of school-based childhood obesity prevention programs. Journal of

pediatric health care, 23(4), 242-258. Doi:10.1016/j.pedhc.2008.04.008

Evaluation for Objective 2

The public health nurse will compile data obtained from parent volunteers in October 2011 and May 2012, as pertaining to 5th and 6th graders BMI’s, and calculate percentage of BMI decrease with students that have been identified as overweight or obese by May 15, 2012.

Interventions for Objective 3 Increase physical activity for 5th and 6th grade students at

Cheboygan Middle School by 45 minutes a week by incorporating “physical activity breaks or “Energizers*” in the classroom (National Center for Chronic Disease Prevention and Health Promotion, 2010, para. 3),” along with encouraging increased physical activity at home or after school.

Physical education instructor will incorporate new activities into gym class to keep students motivated. (See EBP: Summary of SPARK)

Keep the gymnasium open after school for an extra hour to encourage kids to stay after school and play in the gym.

Increase knowledge of why physical activity is good for you; explore different activity options such as Frisbee, football, basketball, non-competitive games, and badminton. (See EBP: 5-2-1)

The classroom in each grade with the most increase in physical activity and increased intake of fruits and vegetables at the end of each 3 month time span “wins” a field day to a local park or roller rink or physical activity of choice.

Medford Public Schools. (2010). Health and physical education. Retrieved from: http://www.medfordpublicschools.org/departments-programs/health-physical-

education

National Center for Chronic Disease prevention and Health Promotion. (2010). Healthy youth! Make a difference: Key strategies to prevent obesity. Retrieved

from: http://cdc.gov/HealthyYouth/keystrategies/get-started.htm

Wechsler, H., McKenna, M. L., Lee, S. M., & Dietz, W. H. (December 2004). The role of schools in preventing childhood obesity. In The state education standard.

Retrieved from: http://cdc.gov/HealthyYouth/physicalactivity/pdf/roleofschools_obesity.pdf

EBP: Summary of SPARKSPARK (Sports Play & Active Recreation for Kids)

The focus of SPARK is the development of healthy lifestyles, motor skills, movement knowledge, social and personal skills.

It is expected that SPARK Physical Education/Physical Activity students will:

Enjoy and seek out physical activity.

Develop and maintain acceptable levels of physical fitness.

Develop a variety of basic movement and manipulative skills so they will experience success and fee comfortable during present and future physical activity pursuits.

Develop the ability to get along with others in movement environments (E.g., share space and equipment, employ the “golden rule” of competition-be a good sport, and demonstrate cooperative behavior). (SPARK, 2011, para. 1)

Sparkpe.org has around 15 different sample lesson plans for different grades, some of the lesson plans are for basketball, dance and rhythms, Frisbee, golf, hockey, soccer, & softball. Sparkpe.org also offers a Balance My Day-Nutrition Education Curriculum, with 30 lessons in each curriculum that take 15-25 minutes each.

SPARK. (2011). SPARK objectives. Retrieved from http://www.sparkpe.org/about-us/objectives/

EBP: Summary of 5-2-1

5 or more servings of fruits and vegetables

2 hour limit on television and screen-time

1 hour of physical activity daily

Parents know their kids have to lose weight, but don’t know what to do, 5-2-1 is easy to remember

5-2-1 simplifies the CDC evidence-based guidelines for childhood obesity prevention into a functional concept, is also a simple and clear concept

Malepati, S., Pirani, H. Surie, D. Dietz, D., Lee, J., & Chockley, N. (2007). Childhood obesity: Harnessing the power of

public and private partnerships. Retrieved from http://www.nihcm.org/pdf/FINAL_report_CDC_CO.pdf

Evaluation for Objective 3

The public health nurse will compile physical activity logs for the 5th and 6th graders at the Cheboygan Middle School as collected by the health education instructor throughout the 2011-2012 school year, and will calculate percentage of students that reported achieving thirty minutes or more of physical activity per day by May 15, 2012.

Interventions for Objective 4

Increase the number of servings of fruits and vegetables that are served during school breakfast and lunch to three servings.

Increase knowledge of healthier foods and food choices by providing teaching of healthy food choices and handouts with lists of healthy food choices, focusing on fruits and vegetables. This is to be done by individual classroom teachers or the health education teacher. (See EBP: Summary of We Can & Summary of Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents).

Increase fruits and vegetables in the classroom by introducing a new or different fruit or vegetable each month for the students to try; have local grocery stores or parents donate food items.

Increase fruits and vegetables on the menu by having the school dietician incorporate one new or different food each month, with most months having a theme food (September is “apple month,” incorporate different ways of having apples into September (applesauce, sliced apples, or apples with caramel dipping sauce).

EBP: Summary of We Can“We Can! (Ways to Enhance Children’s Activity & Nutrition) is a national movement designed to give parents, caregivers, and entire communities a way to help children 8 to 13 years old stay at a healthy weight.

Research shows that parents and caregivers are the primary influence on this age group. The We Can! National education program provides parents and caregivers with tools, fun activities, and more to help them encourage healthy eating, increased physical activity, and reduced time sitting in front of the screen (TV or computer) in their entire family” (National Heart Lung and Blood Institute, 2011, para. 1-2)

The wecan.nhlbi.nih.gov website has a “go, slow, whoa” download to teach kids what foods they can “go” eat almost anytime, “slow” eat sometimes, and “whoa” eat once in a while.

National Heart Lung and Blood Institute. (2011). About We Can! Retrieved from http://www.nhlbi.nih.goov/health/

public/heart/obesity/wecan/about-wecan/index.htm

EBP: Summary of Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents

This study looked at the correlation between sugar-sweetened beverages and weight gain in adolescents. The study found that if sugar-sweetened beverages were eliminated from the diet or the amount consumed was reduced, the adolescents were able to reduce their weight thus lowering their BMI based upon their baseline BMI rates.

Ebbeling, C. B., Feldman, H. A., Osganian, S. K., Chomitz, V. R., Ellenbogen, S. J., & Ludwig, D. S. (2006). Effects of

decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study.

In Pediatric 117(3), 673-680. Doi:10.1542/peds.2005-0983

Evaluation for Objective 4

The public health nurse will compile food diaries for the 5th and 6th graders at the Cheboygan Middle School, as collected by the health education instructor throughout the 2011-2012 school year, and will calculate percentage of students that reported achieving five servings of fruits and vegetables per day by May 15, 2012.

ReferencesAmerican Academy of Child and Adolescent Psychiatry. (May 2008). Obesity in children and teens. Retrieved from http://www.

aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens

CBS News. (September 20, 2007). Katie Couric’s notebook: Obesity in America (CBS News). Retrieved from

http://www.youtube.com/watch?v=P_1u_RVaULE&NR=1&feature=fvwp

Centers for Disease Control and Prevention. (February 14, 2011). Division of nutrition physical activity and obesity. Retrieved

from http://www.cdc.gov/nccdphp/dnpa/index.html

Centers for Disease Control and Prevention. (February 15, 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

City-Data.com. (2010). Cheboygan County, Michigan (MI). Retrieved from http://www.city-data.com/county/Cheboygan_

County-MI.html

Ebbeling, C. B., Feldman, H. A., Osganian, S. K., Chomitz, V. R., Ellenbogen, S. J., & Ludwig, D. S. (2006). Effects of

decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study.

In Pediatric 117(3), 673-680. Doi:10.1542/peds.2005-0983

Ehrke, H. (January 28, 2011). NURS 340 Windshield Survey of Cheboygan County

Healthy Kids, Healthy Michigan. Retrieved from http://www.healthykidshealthymich.com/hkhm-press-releases.html

Krebs, N. F., & Jacobson, M. S. (2003). Prevention of pediatric overweight and obesity. Pediatrics, 112(2), 424-430. Retrieved

from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424#SEC7

Malepati, S., Pirani, H. Surie, D. Dietz, D., Lee, J., & Chockley, N. (2007). Childhood obesity: Harnessing the power of

public and private partnerships. Retrieved from http://www.nihcm.org/pdf/FINAL_report_CDC_CO.pdf

Medford Public Schools. (2010). Health and physical education. Retrieved http://www.medfordpublicschools.org/departments-

programs/health-physical-education/

Michigan Department of Community Health. (2010). Michigan community health information. Retrieved from

http://www.mdch.state.mi.us/pha/osr/chi/IndexVer2.asp

References continuedNational Association of State Boards of Education. (December 2004). Fit, healthy, and ready to learn: Part 1: Physical

activity, healthy eating, and tobacco-use prevention. Retrieved from http://www.cdc.gov/HealthyYouth/physical

activity/pdf/roleofschools_obesity.pdf

National Center for Chronic Disease Prevention and Health Promotion. (2010). Healthy youth! Make a difference: Key

strategies to prevent obesity. Retrieved from http://cdc.gov/HealthyYouth/keystrategies/get-started.html

National Center for Chronic Disease Prevention and Health Promotion. (March 31, 2010). Overweight and obesity. Retrieved

from http://www.cdc.gov/obesity/childhood/index.htm.

National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and SchoolHealth. (November

12, 2008). Healthy youth! Make a difference: Key strategies to prevent obesity. Retrieved from http://www.cdc.gov/

HealthyYouth/keystrategies/why-schools.htm

National Conference of State Legislatures. (2011). Childhood obesity and overweight trends. Retrieved from

http://www.ncsl.org/?tabid=13877

National Heart Lung and Blood Institute. (2011). About We Can! Retrieved from http://www.nhlbi.nih.goov/health/

public/heart/obesity/wecan/about-wecan/index.htm

Peterson, K. E., & Fox, M. K. (2007). Addressing the epidemic of childhood obesity through school-bases interventions:

what has been done and where do we go from here: Journal of law, medicine & ethics, 35(1), 113.

SPARK. (2011). SPARK objectives. Retrieved from http://www.sparkpe.org/about-us/objectives/

U.S. Census Bureau (2009). State and county quick facts. Retrieved from http://quickfacts.census.gov/qfd/states/26/26031.

html

Wechsler, H., McKenna, M.L., Lee, S.M., & Dietz, W.H. (2004). The role of schools in preventing childhood obesity. In The

State Education Standard. Retrieved from http://cdc.gov/HealthyYouth/physicalactivity/pdf/roleofschools_obesity.pdf

Zen, W, & Suha, K. (2008). Integrative review of school-based childhood obesity prevention programs. Journal of

pediatric health care, 23(4), 242-258. Doi:10.1016/j.pedhc.2008.04.008