Childhood Obesity

Erin Hoffman, Yanka Skyton, Lindsey NewnesSteve Shea, Lauren DeLucca, Nikki Bonato

● Childhood obesity rates in the US from 1980 - 2012

o More than doubled in children, age 6 - 11

7% to nearly 18%

o Quadrupled in adolescents, age 12 - 19

5% to nearly 21%

● In 2012, more than ⅓ of children & adolescents were overweight or obese.

Health Risk or Health Problem

Why is Obesity a Problem?

Obesity can lead to:● Coronary Heart Disease ● Heart Attack● Heart Failure● Hypertension● Stroke● Type 2 Diabetes● Liver Disease● Kidney Failure● Metabolic Syndrome● Breast Cancer● Colon Cancer● Gallbladder Cancer● Endometrial Cancers● Other Cancers

● Sleep Apnea● Obesity Hypoventilation Syndrome● Menstrual Issues● Infertility● Gallstones● Enlarged gallbladder● Poorly functioning gallbladder● Blindness● Self image issues● Discrimination● Osteoarthritis ● Other Joint Problems

A Vision of a Healthier Generation

"Imagine a world where children were fed tasty and nutritious, real food at school from the age of 4 to 18. A world where every child was educated about how amazing food is, where it comes from, how it affects the body and how it can save their lives". - Jamie Oliver (Culinary Hall of Fame Chef and Restaurateur)

● The USDA reports:

o A typical school lunch far exceeds the recommended 500 milligrams of sodium; some

districts, in fact, serve lunches with more than 1,000 milligrams.

o Less than 1/3 of schools stay below the recommended standard for fat content in their

meals.

● Last year 21 million students relied on free and reduced cost lunches as their primary meal of

the day.

o School provided meals account for up to 65 percent

of their daily calorie intake.

Health Risk or Health Problem

School age ChildrenSociety local and total

This set of graphs was chosen because of the sheer amount of data that is gatherable in a socialized country and the discernable changes in technology between decades with probable linkage to activity level.

Social Determinants

● Access and availability for diet and exercise

○ Resources

○ Community

■ rural/urban-this is also an overall trend

■ locality- access (grocery and parks)

Societal Development

Mirror image of adult society● Technology/ industrialized mass

production ○ Urbanization - change in

lifestyle.○ More and cheaper but not

necessarily quality.○ Vocational and recreational

changes

Societal Development

Public Health Policy

● Accessibility and affordability of healthy food in vulnerable areas

● Effects of taxation and advertising of food of poor nutritional quality on obesity rates

● Limit access to junk food & drinks in public schools

Effective Health Legislation

NYC 2008 Green Cart Initiativeo 1000 permits issued for sale of fruits and veggies

(Green Carts) in the areas where the consumption of fruits and veggies was the lowest

o Accepting food stampso availability of healthy foods to the most affected

populationo demand for healthy food overtime (Leggat, 2012).

Public Health Policy

“Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption,and which are therefore extremely proper subjects of taxation."

~ Adam Smith, The Wealth of Nations (1776)

S.2342 - Stop Subsidizing Childhood Obesity Act

S.2342 - Stop Subsidizing Childhood Obesity Act

S.2342 - Stop Subsidizing Childhood Obesity Act

Currently Pending Legislation

S.2342 - Stop Subsidizing Childhood Obesity Act● eliminates the tax deduction that allows companies

to deduct costs associated with advertising food of poor nutritional quality to children

● could reduce the rates of childhood obesity by 5 to 7 percent

● proceeds would go to gov-t fund for providing fruits and veggies to low income families

Local School Wellness Policy● Official policies that guide local educational agencies to establish an

environment of health, well-being & ability to learn through nutrition & physical activity.

● Helps address the unique needs of children in the school district to address childhood obesity

● 2006-2007 all districts were required to establish school wellness policy

● Established by Child Nutrition and WIC Reauthorization Act of 2004

Healthy, Hunger-Free Kids Act● Established in December 2010

● Goal to provide healthier foods and beverages in schools

● Required the USDA establish new nutritional standards for school meals and competitive foods

● Increases federal funding to meet USDA nutritional standards

o largest increase above inflation in >30 years

● $50 million will aid in training of food service workers on how to prepare nutritious meals in schools

New Nutritional Standards

1. whole grain rich product2. 1st ingredient must be a fruit, vegetable, dairy, or protein food 3. “combination foods” have at least ¼ cup fruit or vegetable

OR4. contain 10% of the Daily Value of one of the public health concern nutrients such as potassium, vitamin D, calcium, or dietary fiber.

Challenges Implementing Change● GAO found challenges when implementing the new school lunches

o plate wastingo decrease in student lunch participationo managing food costso planning menuso difficulty with portion size & calorie requirements

● Caused by substantial changes being rolled out in a short time

● Challenges will improve as student and food staff adjust

Colorado State Legislation● CO SB 68: In 2012 Colorado prohibited artificial trans fats being made

available to students in public school.

● CO SB 81: Farm-to-School Healthy Kids Act. Aimed to encourage and provide incentives for school and child care facilities to use state-grown, raised, or processed agricultural products benefiting child health and the local agricultural economy.

Who is Benefitting & How● A meta analysis estimated the value of childhood obesity prevention efforts

and found:o most obese children obese adultso ⅔ normal weight children overweight or obese adultso estimated incremental lifetime medical costs of an obese 10yo who

remained obese into adulthood $16,310 - $19,350 $14 billion health care costs for only obese 10yo (Finkelstein et al., 2014)

● Prevention efforts have potential to improve healthy eating behaviors for more than obese youth, and can last into adulthood.

Nursing and Childhood Obesity

“As the largest group of healthcare professionals, nurses are

well positioned to be influential in preventing, identifying, and

treating obesity and promoting advocacy efforts for multi-

level policy changes necessary to create less obesigenic

environments.”

Budd and Hyman, 2008, p. 111

Professional Organization Position Statements

American Nurses Association“Childhood obesity... is one of the most serious public health threats of this century. Professional nurses are instrumental in collaborating with families, communities, and other health professionals to eliminate this hazard and restore a healthy future to America’s children.”

The National Association of School Nurses“The registered professional school nurse has the knowledge and expertise to promote the prevention of overweight and obesity and address the needs of overweight and obese youth in schools.”

Nursing Implications

A paradox exists that “overnourished” children are often “malnourished” because dense, high calorie foods though

inexpensive and easily accessible are lacking vital nutrients.

Calories: 65 Calories: 300Total fat: 0 g Total fat: 9gVitamins: A, C Vitamins: none

Additional Nursing Implications

Comorbidities now associated with childhood obesity that previously were only associated with adults include:

● Orthopedic: slipped femoral epiphysis● Gastrointestinal: gallbladder disease● Respiratory: sleep apnea● Metabolic: Type II Diabetes● Cardiovascular: acute myocardial infarction● Psychological: low quality of life; equal to that of

children with cancer

Additional Nursing Implications

Some studies have indicated that childhood obesity prompts the development of biomarkers for serious illnesses later in life such as:

● Stunted growth● Joint problems● Early onset of puberty in females● increased risk of depression and alcoholism● Anxiety problems

Advocacy Strategies

● Consider the resources available to most families within the community. ○ for example, proximity to fresh produce and pricing of

sports programs or after-school activities

● Family involvement and understanding increases success rates of programs ○ Encourage the entire family to make lifestyle changes ○ 35% of Hispanic parents didn’t realize child was obese

Policy Development● Policies should include:

o Goals for nutritional education.o Guidelines for food and beverages that are

available at schools.o Guideline for activities to promote proper

nutrition and wellness.o Plans for implementation.o Re-assessment

● Participation by parents, members of the educational system & the community (dieticians, pediatricians, food companies, vendors & others).

● Advocate for federal, state & local governments to increase nutritional education and policy development in the educational system.

● Actively participate in professional organizations that support the creation of policies aimed at reducing childhood obesity.

● Support efforts to preserve and enhance parks as areas for physical activity, to develop walking and bicycle paths, and to promote families use of physical activity opportunities.

● Engage families with parental obesity in prevention activities● Encourage parenting styles that support increased physical

activity and reduce sedentary behaviors● Encourage parental modeling of healthy dietary choices.

Professional Nurses Can Make an Impact

Nurses Can Make an Impact - In Schools

● Identify areas for nutritional improvement within schools.● Act as an advisor to the school board and health committees.

o Education about the impact of proper nutrition on obesity, overall health, learning and brain function.

● Advocate for the availability of healthy food and beverage choices during school lunch, in vending machines & elsewhere in the school.

● Lead or actively participate in the development of new policies related to proper nutrition.o Lead policy implementationo Once implemented, manage the policy & related programs.

● Educate the children, families, school staff and community.o Provide support, follow up and referrals if indicated.

You can make an impact!

In your own practice:

● Stay informed on current local, state and federal policy

● Form your own opinion on policy that relates to childhood obesity

● Be a community leader, advocating for wellness programs and activities

● Serve as a resource to your community for health and wellness information

● Support public health agencies and community coalitions in their collaborative efforts to promote and evaluate obesity prevention interventions

ReferencesAmerican Psychological Association (2010). Retrieved from How parents can confront childhood obesity by fostering environmental change in their communities, Washington, D.C.

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