Research Paper: Childhood Obesity and Nursing Intervention

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Childhood Obesity is a growing healthcare concern for America. As per the statistics from the 2007 National Youth Risk Behavior survey, almost 25% of American high school children are overweight and 13% are clinically obese. [Mashid et.al, (2005)] Childhood obesity has in fact become a global concern. In the UK for instance, one out of every 10 children under the age of six is obese. [Science Daily] Two of the main causes implicated in the surging obesity epidemic among our children are the current trend of unhealthy eating habits coupled with a highly inactive lifestyle. The growing fast food industry has completely altered children's eating habits making them more vulnerable to obesity and other attendant health concerns. Computers and the flourishing online gaming have also contributed to an inactive life style ('couch potato kids') that predisposes children into overweight and obesity disorders. [AACAP] Statistics show that 65% of students failed to meet the recommended level of physical activity. Statistics also indicate that 34% of students consume soda and junk food on a daily basis. [Mashid et.al, (2005)] Despite encouraging initiatives by the government, little progress has been achieved in controlling obesity among children. More energetic and appropriate interventions are to be made. A brief overview of childhood obesity in context of the different risk factors including the socioeconomic factors and appropriate nursing interventions would provide better insight into this growing national health concern.

Childhood Obesity Causes

Before we look at the nursing interventions aimed at reducing childhood obesity, a brief discussion of energy balance and obesity is necessary. One of the main nutritional causes of obesity among children is the increasing consumption of fats and carbohydrates (junk foods). Junk foods are overloaded with carbohydrates. Studies show that only 20% of American people consume the recommended 5 servings of fruits and vegetables per day. Also, 60% of American youth are known to consume excess of fatty foods such as cookies, soda, chips, etc. [John Dorsey, 2008] Increased levels of carbohydrates increases the blood glucose levels, which in turn triggers insulin secretion. Insulin breaksdown the carbohydrates and distributes the energy among the cells. Excess energy is stored as fat. Thus an increase in consumption of high-carb junk foods coupled with inactivity only implies more and more energy being stored in the form of body fat resulting in overweight and obese conditions.

Childhood Obesity: Socio-Demographics

There is clear evidence for a positive association between obesity and low socioeconomic grouping. This can be explained by the fact that children growing up in economically deprived or in the lower income families tend to consume more ready made, cheaper and filling junk food instead of the more costlier and wholesome organic foods. Studies indicate that obesity disproportionately affects children from Hispanic, African-American and Native American races. [Diane et.al, 2007]

Nursing Interventions

The nurse as a community caregiver has an immense role to play in the control of childhood obesity. Also the closer interactions between the families, and the knowledge of their socioeconomic backgrounds enables a nurse to appropriately assess their needs and modify the interventions to greater effect. A recent study by Diane et.al (2007) analyzed the effects of providing nutritional training, exercises and Coping Skills Training (CST) for children and parents and the improvements in the overall BMI, BFP and activity (measured using a pedometer). This study conducted by the Yale School of nursing focused on children enrolled in the Bright Bodies weight management program and their parents. Conducted between Nov 2003 and Sep 2004, this study included a total of 80 parent child dyads with children between ages 7 and 17 and parents between 27 and 77. The participants were divided into the control and experimental groups with both the groups receiving nutrition and exercise education program (NEEP). Only the experimental parents received Coping Skills Training (CST). Additionally the experimental and control group children attended 6 weekly 45 minute sessions involving behavioral modification and NEEP. Baseline data for health outcomes including BMI BFP were obtained and these health indicators were also measures at 3 months and 6 months respectively. Similarly recorded pedometer steps were gathered.

Final analysis revealed that experimental group of parents had lower BMI (p = .003) and BFP (p = .02), and increased pedometer steps (p = .03) compared to the control group. All the groups showed overall improvement. Similarly at 6 months, experimental children also showed lower BMI (p = .08) and BFP (p = .1) and increased pedometer steps (p = .2). The nursing implications are that Coping Skills Training is very effective in controlling overweight and preventing obesity. By using cognitive behavioral modification, nurses can help parents understand the difficulties involved in weight management program so they can cope better with relapse situations and emphasis the role of persistence and adherence to exercising, nutrition and behavioral control. This study attests the importance of CST in a nurse managed weight control program for children. [Diane Berry]

Another recent study by Hudson et.al (2009) explored the 'food intake', 'active play', and 'screen time' and BMI of 96 parent child dyads that participated in 'Head Start', the national childhood education program. The study also examined the parental perception about their Child's weight. The study found a very high obesity rate of 15.6% and also the fact that around (86.5%) of the parents of obese children did not consider their children to be obese. The study concluded cultural beliefs led parents to believe an overweight child to be healthy child. The study also found that the diet of the participating children did not meet the prescribed nutritional recommendations and that inactivity was positively associated with consuming more junk food. (chi (2) = 6.24, p < or = .04). The study authors concluded that pediatric nurses have important roles in counseling parents and children enrolled in the 'Head Start' program. [Hudson et.al, 2009]

Julia et.al (2007) analyzed the Latino's community's perspective of childhood overweight and obesity by interviewing three focus groups -12 fathers, 12 mothers, 8 boys and 4 girls. The interview was designed to gather the perspectives of the participants on the obesity problem that is disproportionately affecting their community. From the gathered information, the researchers ascertained several common themes. Lack of time for instance was a common concern expressed by all the three focus groups. Lack of time prevented parents from preparing nutritious homemade meal and encouraged 'Fast food' consumption. Similarly, parents' safety concerns encouraged children to stay in house and enjoy video gaming or TV watching. Nurses involved in child weight management programs should focus on parent's time management and their perceptions about physical activity. Nurses should help parents understand the importance of physical activity for children and encourage both the parents and children to participate in regular physical training. [Julia et.al (2007)]

Another study focused on parent's food choices and its effect on children. Parents from African-American, Caribbean, and Hispanic races participated in the study and their food choices were examined in terms of their cultural and socio economical contexts and the resulting dietary effects on their children. The researchers concluded that culture sensitive nursing is critical for obesity control among the various groups. For example, nurses can work with the parents to identify their food preferences and adaptations within their ethnic choices. [Sealy YM, 2010] Diane et.al (2009) compared 40 Latin, African-American and Caucasian parents and 40 children who underwent a 12-week nutritional training program. The study results showed that there were no significant differences in BMI (p = .69), body fat percentage (p = .43) and pedometer steps (p = .88) among the three groups at 6 months. Also, among the children there were no noticeable differences in BMI (p = .08), body fat percentage (p = .71), or pedometer steps (p = .09). Particularly the researchers noticed that Latin parents' health responsibility (p < .02) and physical activity (p < .007) were significantly better than the other two groups. The results also suggested that all the communities benefited from the nutritional training program. The study confirmed that Culture sensitive nutritional training is key to controlling overweight and obesity problem. Nurses therefore should have a cultural context when they supervise weight management programs in their community health centers. [Diane et.al (2009)]

Bobby Berkowitz, a nursing professor at the University of Washington and Marleyse Borchard, a doctoral research student from the same University conducted a literature review on the application of nursing skills in controlling childhood obesity. The authors from their experience in Rwanda found that in spite of the poor economic conditions and malnutrition obesity was a very rare condition among Rwandan children. The reason for this was the highly active life style of the Rwandan people where intense physical activity was part of everyday life. The authors also report that in the U.S. people are knowledgeable about obesity and its causes but there is a distinct failure of application of that knowledge. It is here that nurses can play a pivotal role and lead the change. The authors of the literature review concluded that nurses have… [END OF PREVIEW]

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