how can nurses help with obesity research

concluded that there is limited data on the effectiveness of these interventions and that no generalizable conclusions could be drawn. By the time children enter kindergarten their food preferences and the social context associated with food intake are established. Factors Contributing to Overweight and Obesity in Children. Poston et al. Journal of Adolescence, 22, 273-277. (2004). Advocate for the federal government to increase physical activity promotion. The report sums up the evidence collected from healthcare professionals, academics, ... Tooth decay is the most common oral disease affecting children and young people in England, yet it is largely preventable. The literature seems consistent in stating that prevention is more effective than most forms of”corrective” approaches once obesity is established. As we have seen from this review of the literature, studies related to childhood overweight and obesity have used a variety of interventions that have met with some degree of success. Contento, I.R., Basch, C., & Zybert, P. (2003). Campbell et al. Another set of tools, also created through the Turning Point initiative, is based on the social marketing literature. The other was a review of the evidence on the prevention of childhood obesity along with recommendations for clinicians (including physicians and nurses) (Davis et al., 2007). Journal of Community Health. Nurses in community-based or public health settings may be the best-positioned healthcare professionals to take action on the promotion or protection strategies aimed at the prevention of childhood obesity. Annals of Medicine, 32, S19-S25. Arnold suggests nurses expand their own nutritional knowledge base by attending dietician conferences and that they get involved with state legislatures. These approaches include advocacy at the policy level, collaborative leadership for leading change within a community, and skills for planning social marketing campaigns to change the conditions and behaviors of individuals or populations. Although higher socioeconomic status (SES) is associated inversely with childhood obesity among whites, higher SES does not seem to protect Hispanic children against obesity (Crawford, Story, Wang, Ritchie, & Sabry, 2001). Myers, S., & Vargas, Z. Strauss found that decreasing self-esteem in overweight children has been associated with increased rates of sadness, loneliness, and nervousness as well as a greater likelihood to smoke and drink alcohol compared to obese children whose self-esteem increased or remained unchanged. In 2005, the Institute of Medicine (Koplan, Liverman, & Kraak) produced a report that examined the behavioral, cultural, social, and environmental factors related to childhood obesity and identified the approaches showing promise for preventing obesity and overweight in children. An example of a protection strategy is the adoption of a county ordinance that bans the use of trans fat (monounsaturated or polyunsaturated fats) in the preparation of food in fast food chain restaurants. Nurses are confronted with the issue of obesity in a number of ways on a daily basis, but when a patient asks for help in dealing with it, that is when a nurse stands to … Crawford et al. Studies have demonstrated that focusing on increasing intake of healthy foods (fruit and vegetables) may be more useful in decreasing overweight than focusing on decreasing fat and sugar (Perusse & Bouchard, 1999). Evaluation of a social marketing campaign targeting preschool children. Walker, S., & Avis, M. Common reasons why peer education fails. (2004). Although the authors called for further research on evidence-based interventions to prevent childhood obesity, they recommended that because childhood obesity has become such a serious public health problem, immediate actions should be based on the best possible evidence. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. (2004). (2004) pointed to culture as a factor contributing to childhood overweight, in that Latina mothers’ health beliefs and attitudes toward early childhood weight issues often do not match those of health practitioners. According to the National Health and Nutrition Examination Survey (NHANES), increases in childhood obesity were particularly marked in Mexican American and African American children. These nurses are Nurses can also instill this information in parents with obese children to encourage healthy eating at a young age. Weight loss in obese Mexican Americans treated for 1-year with orlistat and lifestyle modification. The Centers for Disease Control and Prevention (CDC) describes children as being at risk for overweight if they are above the 85th percentile body mass index (BMI) and defines childhood overweight as a BMI at or above the sex- and age-specific 95th percentile BMI cut points from the 2000 CDC Growth Charts. Childhood obesity in New York City elementary school students. American Journal of Public Health, 98, 751-757. Studies have shown that foods to which children are routinely exposed shape preferences and consumption. The American Academy of Pediatrics has suggested the provision of parent education on diet to prevent pediatric overweight (Bish, Regis, & Gottesman, 2005). Pediatric Annals, 33, 18-24. & Hayes, M.V. A healthy diet is a key component to reducing weight and overall health. One of the few longer-term studies with a ten-year follow up showed that success factors for childhood obesity interventions included involvement of at least one parent as an active participant in the weight-loss process, increase in activity, and family and friend support (Epstein, 1996). Systematic review of interventions to treat chronic disease risk factors associated with obesity suggests that nurses can affect positive changes in weight, blood pressure, cholesterol, dietary and physical activity behaviour and). A different way to look at the environmental influences on obesity is through the lens of food insecurity. For example, lack of classroom space, equipment, and time were seen as barriers by the teachers. Bellows, L, Anderson, J, Gould, S.M., & Auld, G. (2008). (2008). Poston, W.S., Reeves, R.S., Haddock, C.K., Stormer, S., Balasubramanyam, A., Satterwhite, O., et al. Studies of prevalence of overweight show a greater increase in overweight among children four-years-old and older and less of an increase in those younger. Literature Review of Interventions and Prevention Strategies for Childhood Overweight. Parental pressuring of children to eat and parental degree of concern for childhood overweight has been shown to account for 15% of the variance in a child’s dietary intake (Binns & Ariza, 2004). Pediatric Clinics of North America, 48, 855-878. Because 76% of nurses do not pursue the topic of obesity with patients, they may benefit from education on pursuing sensitive topics during a professional encounter. Retrieved 9.12.08 from www.actionforhealthykids.org/. Because both barriers and benefits are important to understand, it is important to explore why the targets (clients) behave as they do and determine what is meaningful to them. That could change, however, with more opportunities for nurses to participate along with a team of social marketers, health educators, and other leaders and professionals who are interested in more innovative approaches to behavior change. After providing background information on childhood obesity, the authors address factors contributing to childhood overweight and obesity, discuss interventions and strategies that have been used to prevent childhood obesity, and offer skills nurses can develop as they work to prevent childhood obesity, including advocacy, collaborative leadership, and social marketing skills. She holds a PhD in Nursing Science from Case Western Reserve University and MN and BSN from the University of Washington. Early presentation of type II diabetes in Mexican-American youth. International Journal of Obesity, 28, 22-26. Crawford et al. American Journal of Public Health, 98, 1616-1629. The prevalence of overweight has increased progressively, overall and within each subgroup from the early 1980s through 2004 (CDC, 2007). These factors present nurses with the opportunity for both advocacy and action in changing those societal conditions that hamper our ability to prevent overweight and obesity, particularly in children. I (B.B.) The literature supports a family-focused approach to influencing dietary habits of very young children, prevention interventions that start early in childhood prior to established poor dietary patterns, and the need for community support and involvement. Instead, Crawford and colleagues (2001) suggested that environmental changes promoting an increase in energy intake and decrease in energy output are influencing children from various backgrounds. A review of family and social determinants of children’s eating patterns and diet quality. Educating parents about portion sizes for preschoolers. In this case, the public health nurse would need to begin the intervention with the following initial steps of the social marketing process: The exchange chosen must be desirable to the target audience because there will be barriers to pursuing the desired behavior that are not immediately obvious. A family-based, health-centered approach to reduce childhood obesity was re-evaluated by Golan and Crow (2004). This suggested that a family-oriented intervention with the parents as the exclusive agents of change may be superior to a child-only approach (Golan & Crow). Findholt (2007) utilized the Community Readiness Model to initiate a childhood obesity prevention initiative in a rural county. The model engaged community members using key informant interviews to explore six dimensions of readiness (existing prevention efforts, community knowledge of the prevention efforts, leadership, community climate, community knowledge about the issue of obesity, and available resources). At time of follow-up, the mean reduction in overweight for the children (now 14 to 19-years-of-age) in the experimental group was 29%; it was 20.2% in the control group. Obesity Reviews, 2, 149-157. Being overweight or obese (extremely overweight) can contribute to type 2 diabetes in childhood and increase the risk of cardiovascular disease in adulthood. The Learning Connation: The value of improving nutrition and physical activity in our schools . In this model, disparities in healthcare access are multifactorial. Johnson, Bellows, Beekstrom, and Anderson (2007) have provided another example of a social marketing campaign related to healthy eating. Individual financial means to acquire healthy foods, as well as the distance individuals live from both healthy and unhealthy food sources undoubtedly play a role in the maintenance of healthy dietary habits. (2003) stated that Mexican Americans are predisposed to develop more atherogenic patterns of body fat distribution and that early weight gain and centralized and upper body fat have been associated with the onset of diabetes in Mexican Americans. Turning Point, an initiative of the Robert Wood Johnson Foundation, developed a curriculum for teaching the skills of collaborative leadership and a set of tools for facilitating the collaborative leadership mode (Berkowitz & Nicola, 2003). Washington, DC: The National Academies Press. Crawford et al. While the target for the behavior change was the preschoolers, the Head Start and preschool teachers were actually the target audience for the change because they needed to offer the physical activity in the classroom. (1994). The literature cited in this article is just a small sample of a wealth of information and research on childhood obesity, factors that contribute to childhood obesity, and opportunities for prevention and treatment. Application of the community readiness model for childhood obesity prevention. Gebbie, Wakefield, and Kerfoot (2000) examined a sample of nurses in America who held active health policy positions at all levels of government and organizations to understand the meaning of this practice. Washington, DC: U.S. Government Printing Office. Given the preponderance of evidence in the research literature that childhood obesity is a significant risk factor for future health problems, this obesity is considered a major public health problem. Encourage parenting styles that support increased physical activity and reduce sedentary behaviors. Food insecurity and obesity: A comparison of self-reported and measured height and weight. She joined the faculty at the University of Washington in July 1996 after having served as Deputy Secretary for the Washington State Department of Health and Chief of Nursing Services for the Seattle-King County Department of Public Health. They spend more years in ill health and die sooner. Thorpe, L.E., List, D.G., Marx, T., May, L., Helgerson, S.D., & Frieden, T.R. Physical and psychosocial effects of moderate to severe overweight can include: hyperlipidemia, increased growth in puberty and then stunting, early onset of puberty in females, obstructive apnea, pancreatitis, gall bladder disease, hypertension, polycystic ovary syndrome, and long-term damage to the cardiovascular system (Barlow and the Expert Committee, 2007). Journal of Nursing Scholarship, 32, 307-315. The desired behavior change, less television time, should be “exchanged” for something that is desirable for the family including the child. This model has a set of tools that helps a group establish shared leadership, trust, insight into the need for change in the community, an understanding of human behavior and power, and the capacity to use self reflection in understanding how one’s own behavior impacts others. Lyons, Park and Nelson (2008) studied the relationship between these dimensions of food insecurity and obesity. A review of these various factors will lead to a discussion on interventions for preventing childhood obesity. Of particular importance to public health practice, the authors (Koplan et al.) Epstein, LH. They made the following recommendations for immediate actions: Again, nurses can play an important role in helping children achieve this energy balance. Three community-based approaches may be particularly powerful for nurses to establish as part of their professional practice. It was interesting to note that Wofford also found most professional recommendations or guidelines were limited by a lack of an evidence base. As stated earlier, with overweight comes the risk of further health problems. Dr. Berkowitz directed the National Institute of Nursing Research (NINR)-funded Center for the Advancement of Health Disparities Research at the UW School of Nursing from 2002 to 2007; from 1998 through 2006 she directed the National Program Office for the Robert Wood Johnson Foundation (RWJF)-funded Turning Point Initiative. Crawford, P.B., Gosliner, W., Anderson, C., Strode, P., Becerra-Jones, Y., Samuels, S., et al. Koplan, J.P., Liverman, C.T., & Kraak, V.A. For these groups prevalence increased by more than 10 percentage points between 1988-1994 and 1999-2000, compared with an increase of less than 5 percentage points for white children (Thorpe et al., 2004) It is estimated that in the US, 39.9% of Mexican American 6 to 19-year-old children are at risk of overweight or are currently overweight. Research related to both factors will be discussed below. From the early 1980s to 2004, these data are available for race and ethnic subgroups, including non-Hispanic White only, non-Hispanic Black only, and Mexican Americans. The National Center for Health Statistics (NCHS) Chartbook, Health, United States (2007) provides data on the prevalence of overweight for children from 6 to 19 years of age based upon national studies completed from the mid-1960s to 2004. In other words, the family needs to identify “what is in it for them” so that they will make the behavior change. Pediatric Nursing, 26, 23-43. Journal of the American Medical Association, 291, 2847-2850. The risk factors associated with obesity that threaten the public’s health, and the multiple and interrelated factors associated with childhood overweight and obesity, are well documented in the literature. The basics of social marketing. Pediatrics, 105, 1-5. Clearly, there is a need for work on evidence-based guidelines, including nursing guidelines, to address obesity. 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