Childhood Obesity and Nutrition

1. Stephanie M. Richards, R.N. Northeastern State University EBP Symposium April 23, 2010 srichards0119@yahoo.com Childhood Obesity and Nutrition

2. Clinical Problem Childhood obesity is an increasingly emergent issue in public health today. According to Shepherd (2009) almost one-third, nearly 3 million children aged 2-15 are classified as overweight, with 29% being classified as obese (p.172). It is estimated that 70% of overweight children will become obese adults (Dehghan et al.).

3. PICO Question? In children who are at risk for becoming overweight or obese, does parental education on exercise and nutrition decrease the risk of developing obesity and the health problems associated with obesity?

4. Significance of Problem Childhood obesity is a huge problem and continues to grow to epidemic proportions. The habits a child is taught and learns can impact them throughout a lifetime. Childhood obesity can lead to adult obesity which brings about adult health problems such as cardiovascular disease and diabetes mellitus type II. Obesity not only affects individuals, but the economy as well. Estimated costs linked to obesity are high and expected to rise. One estimate suggests that the direct and indirect cost of obesity in the United States was about $139 billion in 2003 (Li & Hooker, 2010).

5. Impact of Problem Obesity affects all ages and is a growing epidemic worldwide. �The most influential individuals in an at-risk-for overweight or overweight child�s life are his or her parents� (Doolen, Alpert, & Miller, 2009, p. 161). Children learn from their parents. May even be disconnect between child�s weight and parents perception or behaviors. If parent is overweight, their child may be at risk and they may not even recognize it.

6. Impact Cont�d Several studies indicate that the risk for obesity begins in utero or infancy and depends on multiple factors such as maternal weight gain, birth weight, and feeding habits (bribery, forcing children to clean their plates, extreme restrictions on snacks and preferences). Other factors to consider include socioeconomic status, education level, public or private school, lifestyle choices, participation in activities.

7. Impact Cont�d Approximately one-half of obesity related health care costs are paid by taxpayer dollars through the Medicaid and Medicare programs, $3 billion of which paid for overweight care of children with Medicaid funds (Doolen et al., 2009, p. 160). Children on Medicaid are six times (1115 per 100,000) more likely to have a diagnosis of overweight compared to children with private insurance (195 per 100,000) coverage (Doolen et al., 2009, p. 160).

9. Literature Review According to a survey by the National Survey of Children�s Health(NSCH) conducted by the Centers for Disease Control and Prevention (2003 & 2004), regardless of socioeconomic status, children who attend public schools are associated with higher body mass index than those attending private schools. The Omnibus Appropriations Act of 2009 allocated $78 million for the Carol M. White Physical Education Program which initiates, expands, or improves physical education and after school activities for students K-12.

10. Literature Review Cont�d In 2003, Arkansas enacted Act 1220 of 2003 to address the epidemic of childhood obesity. This act required each public school student to have their body mass index assessed and reported annually to parents. Prior to the passing of this act more than 60% of adult Arkansans were either overweight or obese, ranking Arkansas as the 14th heaviest in the nation (Justus, Ryan, Rockenbach, Katterapalli, & Card-Higginson, 2007).

11. Literature Review Cont�d Speroni et al. (2008) conducted a study on a hospital based community program which implemented fitness and nutrition education for children. The Kids Living Fit (KLF) program consisted of exercise and nutrition education, focused on best lifestyle choices regarding daily activities chosen and foods consumed. The KLF intervention was effective in decreasing body mass index and waist circumference in children both �at risk� for becoming overweight and those who were overweight.

12. Literature Review Cont�d Sixty-five percent of Oklahoma adults are either overweight or obese, and 31% of Oklahoma youth are either overweight or at risk of overweight (www.ok.gov). The associated cost of obesity in Oklahoma is nearly $1.3 billion each year (www.ok.gov).

13. Literature Review Cont�d In 2004, the Oklahoma State Department of Health Chronic Disease Service was awarded a cooperative agreement from the Centers of Disease Control and Prevention to address obesity issues in Oklahoma. Oklahoma Physical Activity and Nutrition Program(OKPAN) was formed. The purpose of the funding was to help Oklahoma build state capacity to address the issues surrounding obesity and obesity related chronic diseases, develop a physical activity and nutrition state plan to coordinate and inform the future.

14. Literature Review Cont�d OKPAN partnered with the Oklahoma Fit Kids Coalition to create a task force comprised of many different partners to develop strategies in five focus areas: physical activity, breastfeeding, screen-time, healthy eating, surveillance and evaluation. The implementation of these strategies will help Oklahomans reach the following goals: healthy eating and active lifestyle choices available and accessible in all settings, reduced rates of obesity, reduced rates of obesity-related chronic diseases (www.ok.gov).

15. The Infancy Connection The �fetal origins hypothesis� states that fetal undernutrition in utero may result in disproportionate neonatal growth. Subnormal fetal growth occurs due to maternal undernutrition in mid to late gestation, which can lead to reduced birth weight and subsequent catch-up weight gain causing an increased risk of childhood obesity. There is a growing body of evidence that extremes of birthweight, either high or low, can place infants at risk for obesity (Snethen, Hewitt, & Goretzke, 2007).

16. The Infancy Connection Low birthweight due to malnutrition in utero leads to rapid weight gain postnatally. Rapid weight gain in the first four months of life has been found to increase the risk of obesity in school-aged children (Snethen, Hewitt, & Goretzke, 2007). Low birthweight has also been associated with central adiposity, metabolic syndrome, hypertension, cardiovascular disease, and type II diabetes in adults.

17. The Infancy Connection Several studies report that breastfeeding is associated with a decreased risk of obesity and has a small but significant protective effect on the risk of childhood obesity. Breastfeeding and some parental behaviors associated with feeding are thought to influence the infant and the child�s ability to �self regulate� dietary intake and, therefore, the subsequent risk of obesity (Snethen, Hewitt, & Goretzke, 2007).

18. Infancy Connection-Feeding Transition Mothers who breastfed their infants were more responsive to the hunger and satiety cues of their infants and used lower levels of control over infants� food choices, amounts and frequency when feeding their children as toddlers when compared to mothers whose infants were fed formula (Snethen, Hewitt, & Goretzke, 2007).

19. Cont�d The benefits of breastfeeding include fewer ear infections, improved cognitive function, protection against immune-related diseases and the greater likelihood that infants will self-regulate food intake.

20. Approach to the Problem Educate, educate, educate!! It is our responsibility to educate parents and children on proper nutrition and importance of physical activity. Collaborate with other health care providers, especially school nurses, teachers and the community to educate and inform the public. Promote smoking cessation and provide resources to quit. Smoking can disturb growth and places children at risk for becoming overweight, among increasing the risk for other illnesses (Snethen, Hewitt, & Goretzke, 2007).

21. Approaches Cont�d Begin education early, starting in utero. Educate expecting mothers on the importance of maternal nutrition and how it affects the baby. Advocate for breastfeeding. Provide information about the benefits of breastfeeding and provide resources that may be able to help such as WIC (Women, Infants, and Children) a program that provides assistance to pregnant women and children by assisting them with nutritional needs. WIC will even provide breast pumps and other aides to help the initiation and continuation of breastfeeding. They will also provide a greater variety and quantity of foods to breastfeeding mothers (www.ok.gov).

22. Cont�d Access to the resources without regard to cost is a key to the continuance of breastfeeding. Educate mothers on strategies to incorporate breastfeeding into their already busy lives and provide resources. Extensive education is key and begins with parents, as this is where children learn their habits.

23. Leadership Support Parents play a major role. The support of the community, schools, healthcare providers and teachers is needed. Politicians must recognize that this is an emerging issue in public health and advocate for policies and funding to make a change. Childhood obesity leads to adult obesity and children are tomorrow�s future. Consumers need to have healthy, affordable choices.

24. Thank You! Any Questions?