Childhood Obesity by Molly London

Childhood obesity has increased at an alarming rate over the last 20 years. Today, nearly one in five children is battling this condition and if patterns predict the future, almost all of America’s children will be living with diabetes, heart disease, and dying younger due to obesity within the next 20 years.

Childhood obesity has increased at an alarming rate over the last 20 years. Today, nearly one in five children is battling this condition and if patterns predict the future, almost all of America’s children will be living with diabetes, heart disease, and dying younger due to obesity within the next 20 years. The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through proper education of prevention, lifestyle changes, and offering treatment options for obesity.

Childhood obesity alone is not the only issue facing children today, although being overly large may inhibit the child from living life to the fullest. However, the co-morbidities relating to childhood obesity are the real killers. Hypertension, type 2 diabetes, respiratory ailments, sleep apnea, and depression are just some of the common problems linked directly to obesity in children (Henry 2005). Others are increased likelihood of having elevated cholesterol, raised systolic blood pressure, experience of early menarche which links with future instances of breast cancer, and increased risk for cardiovascular disease (Ruxton 2004). All of these issues are associated with childhood obesity, and this is a fact that many people do not realize. Steps must be taken to prevent obesity and to promote wellness in children of all ages in order to save America’s children.

First, nurses can influence prevention through sharing information on misunderstood topics. Many people do not know which food choices will keep their children healthy, and these healthy choices should begin at infancy. Numerous women choose not to breastfeed their infants and according to a study done by Mayer-Davis, et al. (2006), breastfeeding can decrease the incidence of overweight/obese children by 13-22%. It is the concern for the children that many mothers say is the reason they do not want to breastfeed, as the mothers are either obese or battling diabetes and don’t want to transfer their health problems into their infant through diet. However, the study conducted proved that regardless of the mother’s weight and diabetic status, the infant equally benefited from the mother’s breast milk (Mayer-Davis 2006). Another piece of information that many people do not realize is the long-term health problems related to childhood obesity. In a separate study done by the American Obesity Association (AOA), over 30% of parents were concerned of their children’s weight, yet only 5.6% of those parents chose “being overweight or obese” as their child’s greatest long-term health risk (Childhood Obesity). These parents need to be told that their children are at risk for poor organ functioning due to large amounts of fat inhibiting normal function, that the excess weight will place unnecessary strains on growing joints and limbs, and that the adipose tissue will have major effects on the metabolic and endocrine systems (Ruxton 2004). Discussing the long-term effects of childhood obesity can play a crucial part in prevention because, as the AOA’s study confirms, people are not aware of the permanent effects this disease can have on a child. Prevention and education are key to battling childhood obesity, but once the knowledge is there, the lifestyle changes must be implemented.

Lifestyle changes will be crucial to reverse childhood obesity if prevention measures are not taken or are unsuccessful. The nurse should teach that lifestyle changes include diet appropriate for the growing child as well as increased amounts of physical activity. Many professionals (i.e. pediatricians, pediatric nurse practitioners, and registered dieticians) are hesitant to put a child on a diet because the child is still growing into his/her body; however, it is appropriate to limit the amount of high fat foods and soft drink consumption while encouraging low-fat dairy products, breakfast each day, and an increase in fruit and vegetable intake (Barlow 2002, Ruxton 2004). Creating a healthy eating environment can help teach kids to make healthier choices; such as assisting with meal preparations, eating slowly to enjoy the family’s time together, and avoiding the use of food as a reward (Childhood Obesity). Along with diet, physical activity is vital to the health of a child. Many children are content to sit in front of a television and play video games for hours at a time. Encouraging physical activity as a family or enrolling the child in a structured activity that he/she enjoys are ways to decrease the amount of TV time, and assigning active chores to every family member is both productive and heart-healthy. Limiting the amount of sedentary time a child is allowed, whether it is computer time, video games, or television time is always a good idea as the child can learn creativity and problem solving outside of the technological world.

Finally, if preventative knowledge and lifestyle changes are not enough, medical-surgical interventions can be implemented. Bariatric surgery for pediatric patients, normally adolescents, has been found to be effective in resolving obesity as well as any obesity-related co-morbidities. This surgery is a last-chance option for these children and should be addressed as so by the informing nurse, as there are many criteria that must be met before a pediatric bariatric surgery will be implemented. For instance, the patient must have a BMI of >/= 40 or be more than 100 lbs. overweight, must have high risk comorbidities, must have a life-threatening cardiopulmonary problem and must have potentially other problems that interfere with lifestyle (Henry 2005). The American Academy of Pediatrics and the American Pediatric Surgical Association have both approved of this method, though they do require additional criteria to be met and they reach the conclusion that bariatric surgery is the answer much more slowly than other organizations. One final point the nurse should make very clear to families discussing this option is that Medicare has recently passed a bill stating that adult obesity is a disease and therefore will be covered by insurance as a disease. However, childhood obesity is not yet labeled as a disease; therefore, families will likely bear the entire cost of this surgical procedure (Henry 2005).

Obesity does not merely inhibit a child from living a normal life, but prevents the child from having a healthy and favorable future. With the rate of childhood obesity increasing like it is, all children will likely become affected in one way or another. The educated nurse must intervene to promote healthy lifestyle behaviors for obese children, as well as educate on prevention, changes in lifestyle and offer treatment options for obesity.


A. Intervention 1: The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through lifestyle changes.
I. Disadvantage 1: Knowledge Deficit
A parent’s lack of knowledge is a difficult barrier to cross when trying to implement lifestyle changes for an obese child. The skewed thoughts of the parents are often what enable the child to continue with unhealthy lifestyles. In a study done by Myers and Vargas, about 80% of parents understood that obesity led to heart disease and had negative long-term effects; however, only 5% of the parents thought that an increase in physical activity could decrease their child’s weight and only 3.5% understood that decreasing their child’s consumption of soda and Kool-Aid could help their child’s weight loss. Others thought their child was slightly overweight when the child was well beyond the recommended weight for his/her age, but were not concerned with any long-term health risks (Myers, Vargas 2000).
II. Disadvantage 2: Low Socioeconomic Status
Lifestyle changes are also difficult to implement in a family of low socioeconomic class. When there is no money for healthy food choices, which are by far the more expensive foods, families will tend to choose quick, cheap food choices that are higher in fat and calories. Lack of financial means is also related to decreased physical activity. The cause is not certain, but one can assume that many organized activities require some sort of fee and those of low socioeconomic class may not have the funding to participate in those organized physical activities. A study found that there was a direct correlation between low socioeconomic status and sedentary lifestyles with poor dietary choices, though the authors noted that additional longitudinal studies should be done to confirm these findings (Lioret et al 2008).

B. Intervention 2: The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through offering treatment options for obesity.
I. Disadvantage 1: Lack of Insurance Coverage
Medicare has recently declared adult obesity to be a disease, and therefore covers any interventions needed to change the adult’s obesity status. However, childhood obesity is not considered a “disease” and therefore is not covered by most insurances, since many insurances follow Medicare’s lead on deciding coverage. Though bariatric surgery is considered elective for most children and is a last resort in most situations, some children’s lives depend on losing weight rapidly. Diabetes, heart disease, and organ failure due to increased adipose tissue are among the very serious issues that obese children face, and these factors can be life-threatening and often need to be dealt with immediately. Surgery options should be implemented only if activity levels and lifestyle changes do not affect the child’s obesity status, unfortunately this is not a realistic factor if the insurances do not cover the child’s surgery (Henry 2005).
II. Disadvantage 2: Non-Compliance
Though banding is the most common childhood bariatric surgery, many different methods are used to help a person lose weight. Other methods are: removal of part of the stomach and rerouting the intestines, stapling the stomach, and gastric bypass, all which effectively help a person lose weight but are all a bit riskier than the band. Regardless of which method is used, it can only be successful if the obese person also changes their eating habits and exercise habits. The likelihood of a child changing these habits after surgery is very small, often because the parents are enabling the child to continue with their poor lifestyle choices or the child is not interested in physical activity and continues with their sedentary activities. Unless the child is very mature and responsible enough to make life-changing decisions, compliance is likely to be an issue and needs to be addressed with a psychologist as well as with a dietician, life-counselor and/or exercise physiologist prior to and following the child’s bariatric surgery (Marchione 2006).


REFERENCES:
Barlow, S.E., Trowbridge, F.L., Klish, W.J., & Dietz, W.H. (2002). Treatment of child and adolescent obesity: Reports from pediatricians, pediatric nurse practitioners, and registered dieticians. Pediatrics, (110)1, 229-235. Retrieved January 4, 2007 from Expanded Academic ASAP database.

Childhood Obesity (n.d.). Retrieved February 2, 2007, from
http://www.obesity.org/subs/childhood/prevention.shtml.

Henry, Linda L. (2005). Childhood obesity: What can be done to help today’s youth? Pediatric Nursing, (31)1, 13-16. Retrieved January 4, 2007 from Expanded Academic ASAP database.

Lioret, S., Touvier, M., Lafay, L., Volatier, J.L. & Maire, B. (2008). Dietary and physical activity patterns in French children are related to overweight and socioeconomic status. The Journal of Nutrition (138)1, 101-107. Retrieved February 3, 2008 from Expanded Academic ASAP database.

Marchione, Marilynn. (2006). Weight-loss surgery growing: Doctors, patients debate which kind of procedure is best. Columbian. Retrieved February 3, 2008 from Expanded Academic ASAP database.

Mayer-Davis, E.J., Rifas-Shiman, S.L., Zhou, L., Hu, F.B., Colditz, G.A., & Gillman, M.W. (2006). Breast-feeding and risk for childhood obesity: Does maternal diabetes or obesity status matter? Diabetes Care, (29)10, 2231-2238. Retrieved January 4, 2007 from Expanded Academic ASAP database.

Myers, S. & Vargas, Z.. (2000). Parental perceptions of the preschool obese child. Pediatric Nursing, (26)1, 23-30. Retrieved February 3, 2008 from Expanded Academic ASAP database.

Ruxton, Carrie. (2004). Obesity in children. Nursing Standard, (18)20, 47-55. Retrieved January 4, 2007 from Expanded Academic ASAP database.
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