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Obesity Prevention and Education for School Nurses

Obesity Prevention and Education for School Nurses. The planning committee & faculty attest that no relevant financial, professional or personal conflict of interest exists, nor was sponsorship of commercial support obtained, in the preparation or presentation of this educational activity.

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Obesity Prevention and Education for School Nurses

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  1. Obesity Prevention and Education for School Nurses

  2. The planning committee & faculty attest that no relevant financial, professional or personal conflict of interest exists, nor was sponsorship of commercial support obtained, in the preparation or presentation of this educational activity.

  3. Objectives • Define obesity and relate current trends in Arkansas and in the US. • Discuss risk factors for childhood obesity. • Explain health consequences of obesity. • Describe importance of health assessment especially blood pressure monitoring in regards to childhood obesity. • Explain the relationship between Acanthosis nigricans and obesity. • Describe the process for appropriate height and weight measurement for children. • Review pertinent legislation. • List resources available for schools and school nurses to combat childhood obesity.

  4. Obesity Trends

  5. Definition of Obesity Obesity is defined as an increased body weight in relation to height, when compared to some standard of acceptable or desirable weight.

  6. Obesity / Overweight in Children Obesity in children / youth refers to age and gender- specific BMI that is equal to or greater than the 95th percentile of the CDC BMI charts Overweight/at risk for obesity between 85th – 94th percentile (IOM, 2007)

  7. In the Past Three Decades… Number of overweight: • 6-11 year olds tripled • Adolescents tripled (Gerberding & Marks, 2004) • Overweight adults tripled (>60%)

  8. Obesity in Children 16.3% of children and adolescents ages 2 -19 years are obese • 11% considered extremely obese • 12.4% 2 - 5 year old • 17.4% 6-11 year olds • 17.6% 12-19 year olds 31.9% are overweight / obese (Ogden, JAMA, 2008)

  9. Obesity in the United States http://www.cdc.gov/obesity/data/trends.html

  10. 2009

  11. Trends in Obesity Among Boys

  12. Trends on Obesity Among Girls

  13.  9 million children >6 yrs obese(IOM, 2005)  25 million children / adolescents are obese or overweight (NHANES, 2007) Males 18.2% Females 16.0 % HHS estimates that 20% of children / youth in the US will be obese by 2010. (GAO-07-260R Childhood Obesity and Physical Activity) http://www.gao.gov/new.items/d07260r.pdf The Epidemic of Childhood Overweight and Obesity

  14. Risk Factors for Obesity

  15. Risk Factors for Obesity:DietInactivity High-calorie foods High-fat foods dense in calories Soft drinks, candy, desserts high in sugar / calories Sedentary kids more likely to gain weight Inactive leisure activities

  16. Risk Factors for Obesity: Genetics Overweight family and child may be genetically predisposed to gain excess weight environment of high-calorie foods physical activity may not be encouraged

  17. Heredity… / Genes  80%of children with two overweight parents will become overweight  40%of children with one overweight parent will become overweight  7–9%of children with no overweight parents will become overweight http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm

  18. Percentage of Overweight Children and Youth Who Become Overweight Adults (National Institute for Health Care Management, Nov 2003)

  19. Some eat to cope with problems or deal with emotions; stress or boredom Parents may have similar tendencies Risk Factors for Obesity:Psychological

  20. Environmental / Media Temptation at Every Turn Chips, cookies, and other less healthy food choices are marketed to children via media.

  21. Behavioral/Socio-cultural Sedentary lifestyles  Calorie-dense foods  Large portion sizes  Excessive television viewing / video games  low energy expenditure Parent modeling - eating and exercise behaviors

  22. Consequences of Obesity

  23. Health Consequences: AdultPremature Death • 500,000 deaths per year – surpassing tobacco • Risk increases with increased weight • (USDHHS, 2001)

  24. Health Consequence: ChildrenRisk of CVD Hypertension Elevated insulin levels Dyslipidemia Elevated low density lipoprotein (LDL) Abnormal triglyceride levels

  25. Other Health Consequences Children Sleep apnea Asthma Risk for Kidney problems Gastrointestinal fatty liver disease elevated liver enzymes gallstones and cholecystitis gastroesophageal reflux constipation

  26. Other Health Consequences Children Endocrine disorders T2DM Polycystic Ovary Syndrome Early sexual maturation Orthopedic disorders Skin conditions AN – seen in:  10% of obese white children  50% of obese black children Skin fungal infections

  27. Health Consequences: Psychosocial !!! Children • Depression/Anxiety • Quality of Life • Negative self-esteem/Poor body image • Feelings of chronic rejection / Withdrawal from interaction with peers/Behavioral problems • Decreased endurance / involvement • Social, academic and job discrimination (Deckelbaum and Williams, 2001)

  28. Health Consequences for Children – Risk of T2DM Clearly, the growth in the treatment of type 2 diabetes could signal the beginning of a multitude of long-term healthcare needs for many of these children.

  29. Economic Burden of Obesity The Economic Estimates of the impact of obesity are astronomical: 1995 - Approximately $52 billion was attributed to obesity 2003 - This figure had increased to $75 billion(CDC, J. Gerberling, 2005) According to one estimate total health care spending for children who receive a diagnosis of obesity is approximately $750 million a year http://www.medstat.com/pdfs/childhood_obesity.pdf

  30. Economic Burden of Obesity Obesity is the No. 1 driver of increasing health care costs in the US today Diabetes contributes to health care disparities in the United States

  31. Recap: Rising obesity rates - result of a number of trends in the US Americans consume 300 more calories/ day than they did 25 years ago & eat less nutritious foods Nutritious foods are…more expensive than calorie-dense, less nutritious foods Americans walk less / drive more -- even for trips of less than one mile Adults often work longer hours & commute farther Parks & recreation spaces are not considered safe or well maintained in many communities Many school lunches do not meet nutrition standards -children engage in less physical activity in school ↑ screen time (TV, video games) contributes to ↓ activity…for children (F as in Fat, 2009)

  32. Assessing the Overweight/Obese Child

  33. Assessment of the Overweight and Obese Child and Adolescent • Hypertension • Acanthosis Nigricans • Nutrition and Physical Activity • Child and Family History • Height/Weight/BMI

  34. Definition of Hypertension Average Systolic blood pressure (SBP)[higher number] and/or diastolic blood pressure (DBP)[lowernumber] that is ≥ to the 95th percentile for gender, age and height on 3 or more occasions

  35. Definition of Pre-Hypertension Average SBP or DBP levels that are greater than or equal to the 90thpercentile, but less than the 95thpercentile Adolescents with BP levels greater than or equal to 120/80 mmHg should be considered pre-hypertensive http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  36. Assessing for Hypertension in Children & Adolescents Approximately 9-13% of overweight children have elevated blood pressure Approximately 30% of obese children (BMI >95th percentile) have hypertension

  37. Blood Pressure in ChildrenLower than an Adult – Normal Blood Pressures 4 91/52 6 94/56 7 96/57 8 98/58 9 100/59 10 100/60 11 102/61 12 104/62 13 106/63 14 107/64 15 109/65 16 110/66 17 110/66 (Selekman, 2006)

  38. Hypertension Overview New national data added to the childhood BP database Updated BP tables now include the 50th, 90th, 95th, and 99th percentiles by gender, age and height http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  39. Blood Pressure Levels for Boysby Age and Height Percentile http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  40. Blood Pressure Levels for Girls by Age and Height Percentile http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  41. How To Use The BP Tables Use the standard height charts to determine the height percentile Measure & record the child’s SBP and DBP Use correct gender table for SBP and DBP Find child’s age on the left side of the table Follow the age row horizontally across the table to the intersection of the line for the height percentile (vertical column) http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  42. For SBP percentiles in the left columns and for DBP %tiles in the right columns: Normal BP = < 90th percentile Pre-hypertension = BP between the 90th- 94th percentile or > 120/80 mmHg in adolescents Hypertension = BP  95th percentile on repeated measurement http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm How To Use The BP Tables

  43. BP > 90th percentile should be repeated twice at the same office visit BP > 95th percentile should be staged: Stage 1 = the 95th percentile to the 99th percentile plus 5 mmHg. Stage 2 = >99th percentile plus 5 mmHg. http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm How To Use The BP Tables

  44. Blood pressure in children - exercises 1.Boy - 10 y.o. 95th %tile for height – blood pressure 100/60 Blood pressure is 50th percentile = normal

  45. Blood pressure in children - exercises 2. Boy - 12 y.o. 50% %tile for height – blood pressure116/70 Blood pressure is 90th percentile = normal

  46. Blood pressure in children - exercises 3. Girl 9 y.o. 90th %tile for height – blood pressure 118/76 Blood pressure >90th %tile = prehypertension

  47. 4. Girl 16 y.o. 25th %tile for height – blood pressure 126/80 Blood pressure is >90th %tile = prehypertension Blood pressure in children - exercises

  48. Classification of Hypertension in Children and Adolescents http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

  49. Classification of Hypertension in Children and Adolescents http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm

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